Ching-Yuan Chen

Fluorine-18-FDG-PET Demonstrating Malignant Pleural Effusion from Esophageal Carcinoma

Malignant pleural effusion is the most common complicated by primary pulmonary carcinoma, but is seldom in patients with esophageal carcinoma. We present a patient with a 5-6 month history of gradual dysphagia of solid foods and gurgling with liquids whose computed tomography (CT) images of the chest showed left pleural effusion. 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) imaging revealed increased FDG uptake in the distal end of esophagus and in the posterior left chest wall. An aspiration of the left-side pleural effusion was done; cytologic examination of the aspirated effusion was positive for malignancy, consistent with adenocarcinoma of esophagus. The clinical roles of PET imaging in patients with malignant pleural effusion are discussed.

Post Endoscopic Retrograde Cholangiopancreatography Bleeding Documented by (superscript 99m)Tc-Red Blood Cell Blood Pool Imaging

Endoscopic retrograde cholangiopancreatography (ERCP) is a well-accepted diagnostic and therapeutic procedure for patients with hepatobiliary and pancreatic diseases. The procedure carries significant morbidity including acute pancreatitis, perforation, and even aspiration pneumonia. Bleeding complication, however, is rare. We present the case of a patient, who in addition to acute pancreatitis suffered from massive post ERCP gastrointestinal (G-I) bleeding, which was demonstrated by (superscript 99m)Tc-red blood cell (RBC) blood pool imaging study.

Intense and Diffuse Liver Uptake and Mild (Subtle) Multiple Skeletal Metastases on Bone Scintigraphy in a Patient with End-stage of Multiple Myeloma: Correlation with CT and MRI Findings

Diffuse hepatic uptake of bone-imaging agent can be due to a variety of causes including radiopharmaceutical fault of elevation of serum albumin level and hypoxemia secondary to respiratory failure. We present the case of a patient with end-stage of multiple myeloma whose (superscript 99m)Tc-HMDP bone images at 2- and 21-h showed diffusely and intensely increased activity in the liver in addition to subtle skeletal metastases. Concurrent CT, MRI, and subsequent bone radiography survey demonstrated multiple osteolytic lesions in the vertebrae, ribs, scapulae, and pelvic bones without abnormality of the liver.

Variants of Liver Location in Relation to the Cardiac Position on Resting Thallium-201 Myocardial SPECT

Background: On a rest 201TI myocardial SPECT, raw data images are obligated to check possible artifacts during the imaging acquisition. Thus, they may also simultaneously assess the position of the liver and heart. Methods: With the patients in a supine position, rest 201TI myocardial SPECT was acquired by a three-head camera in 146 male patients. Each patients raw data images were viewed by a three-dimensional display to locate activity of the liver in relation to that of the heart. Variants of liver appearances were categorized as small left lobe, large left lobe, Riedel lobe, Chapeau de gendarme, and vertical orientation, concave, flat, and globular liver. The findings of variants of liver location were correlated with the available concurrent chest CT or radiography. Results: Fifty-five patients (37.7%) had high position of the liver; 48 (32.9%) small left lobe; 41 (28.1%) flat liver; 1 (0.7%) large left lobe and 1 (0.7%) concave liver. Among those with high position of the liver, 30 patients had concurrent elevation of the right diaphragm due either to atelectasis or/and chronic changes of the right lower lobe of the lungs; 19 left pleural effusion, and 6 Chapeau de gendarme shape. Emphysema (35) or bilateral pleural effusion (6) accounted for the flat liver. Conclusions: A high position of the liver and a flat liver on resting 201TI myocardial SPECT should lead to cause a search for lungs, pleura, and/or diaphragmatic abnormality such as pulmonary atelectasis, emphysema, or pleural effusion.

Severe Pulmonary Emphysema with Secondary Pulmonary Hypertension: 18F-FDG PET Abnormalities

A 60-year-old male presented with a solitary pulmonary nodule (SPN) in the right upper lobe by computed tomography (CT) of the chest. He was referred for 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) to evaluate the nature of the nodule. FDG-PET images showed downward displacement of both diaphragms with flattened upper boarder of the liver, elongated vertical dimension of the thoracic cavity, and increased radioactivity in the region of the stomach, while there was no definite lesion with increased FDG metabolism in the lungs. In addition, the following cardiac chamber abnormalities were found: thickened inter-ventricular septum, well visualization of the right and left ventricles-thicken free walls of the left and right ventricles. Follow-up chest radiography showed downward displacement of both diaphragms with elongation of vertical dimension of both lungs, consistent with emphysematous changes. CT of the chest with lung window demonstrated emphysematous changes of both lungs, consistent with pulmonary emphysema and enlargement of both ventricles, corresponding to secondary pulmonary hypertension with ventricular abnormalities. In summary, we discovered that incidental detection of unexpected cardiac abnormalities by FDG-PET in patient evaluated for SPN.

Diagnosis of Peritoneopleural Communication with 99mtc-MAA Scintigraphy in A Patient with Continuous Ambulatory Peritoneal Dialysis: A Case Report and Literature Review

Continuous ambulatory peritoneal dialysis(CAPD)is an effective therapy for end-stage renal disease. Hydrothorax is an uncommon complication of CAPD, is possibly secondary to peritoneopleural communications. But the real mechanism is still unclear. Peritoneal scintigraphy is a useful diagnostic tool in the management of complication of CAPD. We present a case of right hydrothorax who was during CAPD using 99mTC-MAA peritoneoscintigraphy.

Discrepancy of Diagnostic and Post-Therapeutic Radioiodine Whole Body Scans in a Follicular Thyroid Carcinoma Patient with Multiple Bony Metastases

A large amount of radioiodine-131 (131I) is the main choice for treatment of follicular thyroid carcinoma with multiple bony metastases. However, the curative rate is not encouraging. A 40-year-old woman who had received a thyroidectomy due to follicular thyroid cancer was referred to our department for the 131I cancer workup. She did not have bone pain or other clinical manifestations regarding bony metastases. Serum thyroglobulin (Tg) value in thyroxine withdrawal was 29.9 ng/mL. The diagnostic 131I whole body scan (WBS, 2 mCi) showed multiple bony metastases. A 200 mCi of 131I was thus given. Interestingly, the image pattern of the post-therapeutic WBS was quite different from that seen on the diagnostic scan, which showed a large decrease in numbers of bony metastases. Therapeutic and/or stunning effects of the diagnostic 131I might contribute to the discrepancy. Negative 131I WBS with stimulated serum Tg values less than 2 ng/mL, however, were found at 6 months and at 2 years after therapy.

Incidental Breast Uptake of Thallium-201 on Myocardial Scintigraphy in a Lactating Woman: Case Report

It was not common that a lactating woman with bilateral breast uptake of 201Tl-thallous chloride (201Tl) on myocardial scintigraphy. We reported such a case. The 38-year-old woman with a one-year-old lactating infant suffered from intermittent chest distress for several months. Electrocardiogram showed intermittent ventricular tachycardia. 201Tl myocardial perfusion scintigraphy was performed and revealed normal perfusion to all segments on stress and rest images. However, there was bilateral breast uptake of 201Tl on delayed 4-h images. Carefully clinical examinations and follow-up studies showed no evidence of breast disease. The enhanced 201Tl uptake of breast was related to lactation and might be due to diffusion of 201Tl into the extravascular space.