Gottlieb L. Turnbull

Abdominal varices mimicking an acute gastrointestinal hemorrhage during technetium-99m red blood cell scintigraphy

Abdominal varices consisting of a caput medusae and dilated mesenteric veins resulted in pooling of Tc-99m tagged red blood cells (RBC) within these dilated vessels in a 57-year-old man with severe Laennecs cirrhosis. The atypical radiotracer localization within the abdomen mimicked an acute gastrointestinal hemorrhage. Clinical suspicion and careful evaluation of scintigraphic gastrointestinal bleeding studies will avoid false-positive interpretations.

One-Dose Technetium-99m Pertechnetate Imaging in Acute Testicular Torsion Followed by Manual Detorsion

The role of technetium-99m pertechnetate imaging in acute testicular torsion is well appreciated. Manual testicular detorsion under local anesthesia may be performed in the nuclear medicine clinic by the urology service immediately following initial diagnostic scintigraphy. Following manual testicular detorsion, continued images of the testes are obtained up to 30 minutes without having to reinject the patient with technetium-99m pertechnetate. Reperfusion of the affected testicle will be dramatically noted if the manual detorsion is successful. Four cases are presented to illustrate this.

Nuclear imaging in Coccidioidal osteomyelitis.

Six cases of osteomyelitis due to Coccidioides immitis are presented. The cases reported demonstrate the importance of performing both bone and gallium imaging to avoid missing the osseous coccidioidal lesions.

The effect of prolonged fasting and total parenteral nutrition on hepatobiliary imaging with technetium-99m DISIDA.

Prolonged fasting (NPO) and total parenteral nutrition (TPN) have been reported to result in an unacceptable number of false-positive hepatobiliary scintigrams for acute cholecystitis. Based on these reports, the clinical usefulness of the hepatobiliary scan in diagnosing acute cholecystitis in the critically ill postoperative patient who has been NPO or on TPN has been questioned. Patients who were either on prolonged fasting or total parenteral nutrition and who had no history of hepatobiliary disease were prospectively studied to assess the value of the Tc-99m diisopropyl-iminodiacetic acid (DISIDA) scan without pretreatment with cholecystokinin (CCK) in such a setting. Of the 17 persons studied, nine had been on total parenteral nutrition for at least five days and eight had been fasting for at least five days prior to imaging. Seven of the nine individuals on TPN (78%) and six of the eight individuals who were NPO (75%) had normal hepatobiliary scintigraphy. The results suggest that hepatobiliary imaging with Tc-99m DISIDA has a lower false-positive rate in individuals on TPN or NPO than previously has been reported and that it has clinical efficacy in ruling out the diagnosis of acute cholecystitis in these individuals.

Cholelithiasis demonstrated on hepatobiliary scintigraphy as a photopenic defect within the inferior portion of the liver

A 47-year-old man presented with the clinical findings of acute cholecystitis. During hepatobiliary scintigraphy using Tc-99m DISIDA, a persistent photopenic defect was noted within the inferior portion of the liver in the region of the gallbladder. Abdominal ultrasonography revealed large gallstones with acoustic shadowing within a normal-sized gallbladder. Eleven large gallstones were found within a normal-sized intrahepatic gallbladder at surgery.

Large Thoracic aortic aneurysm seen on equilibrium blood pool imaging

A 70-year-old man with a history of an abdominal aortic aneurysm had facial edema and conjunctival suffusion. A superior vena cava syndrome was subsequently diagnosed with the cause being a large aneurysm of the ascending aorta. Radionucilde ventriculography clearly demonstrated the aneurysm

Adenomyosis as seen on blood flow and blood pool imaging during bone scintigraphy

A 42-year-old woman presented with intermittent low back and left lower extremity pain. The blood flow and blood pool images of bone scintigraphy showed a large focus of increased activity in the right lower abdomen. Computed tomography showed an enlarged uterus displaced to the right side of the pelvis. At surgery, the uterus was found to be involved with adenomyosis. Three-phase bone scintigraphy consisting of blood flow and blood pool images over the anterior pelvis may be a valuable diagnostic aid in the evaluation of lower back or pelvic pain of a woman.

Serendipitous finding of transitional cell carcinoma of the kidney on bone and gallium imaging

A 50-year-old woman presented with low back pain. Bone scintigraphy showed a focus of increased activity in the upper pole of the left kidney. Subsequent Ga-67 citrate scintigraphy demonstrated this same abnormal focus as a region of increased activity. Ultrasonography showed a renal mass in the upper pole of the left kidney. At surgery a transitional cell carcinoma of the upper pole of the left kidney was found.

Acute cholecystitis in a patient with situs inversus.

A 73-year-old woman with situs inversus presented with left upper quadrant abdominal pain. Nonvisualization of the gallbladder consistent with acute cholecystitis was noted throughout the study. Situs inversus of the liver and bowel was clearly demonstrated.

Imaging in plague

An 8-year-old boy presented with elevated temperature, malaise, hepatoslpenomegaly, mesenteric adenitis, and septic shock. Cultures of biopsied abdominal lymph nodes as well as the blood grew Yersinia pestes. The boys condition improved after two weeks of chloramphenicol and cefotaxime (Claforan). Two days after stopping intravenous antibiotic therapy, the patient again became febrile and complained of abdominal pain. Abdominal imaging with 111In-labeled leukocytes did not show any abnormalities, however, 67Ga-citrate scintigraphy demonstrated an abnormal focus of increased radiopharmaceutical uptake within a confluence of necrosed lymph nodes within the right upper quadrant of the abdomen. In addition, abnormal 67Ga-uptake was seen within the left hip region. Correlative imaging with computed tomography is also presented.