Bruce K. Adams

Fe-52 imaging of intrathoracic extramedullary hematopoiesis in a patient with β-thalassemia

Fe-52 scintigraphy was used to confirm extramedullary hematopoiesis in a patient with beta-thalassemia and intrathoracic masses. Imaging was performed on a standard gamma camera with a high-energy collimator. Tc-99m labeled tin colloid and In-111 chloride scintigraphy failed to reveal uptake by the masses. The exclusion of malignancy obviated the need for invasive diagnostic measures.

Successful Management of a Widespread Osteosarcoma

Objective and Importance: To report the case of a 23-year-old woman with widespread osteosarcoma including skeletal, pulmonary and pleural metastases, who had a remarkable response to combined chemo- and radiotherapy. Clinical Presentation and Intervention: A 23-year-old Indonesian woman presented in October 1999 with a swelling of the right thigh, severe generalized pain and progressive left hemiparesis. Radiological examination revealed osteolytic lesions in the cervical spine. CT scan of the chest showed multiple pulmonary metastases and a huge left pleural effusion. Bone scan with technetium-99m hydroxymethylene diphosphonate showed intense uptake of the radiopharmaceutical in the distal right femur, generalized deposits throughout the skeleton and in the right hemithorax corresponding to the lung findings. Bone marrow and kidney function tests as well as serum calcium level were normal. Alkaline phosphatase was markedly elevated, 8,000 IU/l (normal <250 IU/l). Histopathology from the femoral tumor showed osteosarcoma. Treatment was started with radiotherapy to the cervical spine followed immediately by a combination chemotherapy with ifosfamide, cisplatin, etoposide and mesna rescue. In addition, the patient received bisphosphonates regularly. Eleven cycles of chemotherapy were given with a remarkable response. Conclusion: The patient was successfully treated with a combination of radio- and chemotherapy. She recovered fully and is in almost complete remission. The disease remained stable 24 months after the discontinuation of the treatment.

Tc-99m leukocyte scintigraphy in infective endocarditis

A 56-year-old man with Staphylococcal aureus septicemia and clinically suspected infective endocarditis was imaged using Tc-99m HMPAO leukocytes. Although abnormal uptake was seen at 3 hours after injection, 24-hour images demonstrated marked concentration of radiolabeled leukocytes in a myocardial abscess and large posterior parietal infarct. In addition, multiple splenic infarcts were shown. The Tc-99m labeled leukocyte scan proved to be an excellent whole body screening procedure for diagnosing sites of infection and infarction in this patient.

Tc-99m blood-pool imaging in torsion of an epididymal appendix.

Torsion of an epididymal appendix is one cause of acute hemiscrotum. The authors describe a 12-year-old boy who had two episodes of left scrotal pain within 10 days of hospital admission. Examination of the scrotum revealed a 3-mm dark spot on the skin overlying a tender nodule in the upper region on the left. A Tc-99m pertechnetate flow study and blood-pool images obtained 5 minutes later showed a linear hyperemic focus in the left upper hemiscrotum. Surgical exploration revealed torsion of a left epididymal appendix, which was removed and confirmed by histopathologic examination to be partially infarcted.