Joan M. Mack

Two false-negative results using morphine sulfate in hepatobiliary imaging.

Morphine sulfate has been used in hepatobillary imaging to cause contraction of the sphincter of Oddi, thereby increasing pressure in the biliary tree. If the cystic duct is patent, the increased pressure usually causes bile to flow into the cystic duct with filling of the gallbladder. Using this technique, the authors have encountered two false-negative cases. Both patients received 0.04 mg/kg of morphine sulfate intravenously, 40 minutes after the intravenous administration of 5 mCi of technetium 99m-DISIDA. Although both patients filled their gallbladders within 1 hour, they both underwent surgical exploration because of high clinical suspicion of acute cholecystitis. Both were found to have acute cholecystitis.

Delayed accumulation (flip flop) of Tc-99m DTPA in a leiomyosarcoma.

An 85-year-old woman with leiomyosarcoma occupying the abdominopelvic area had a renal dynamic study with Tc-99m DTPA. The tumor area initially showed almost no content of the radiopharmaceutical. At 24 hours, there was retention of activity in the leiomyosarcoma as compared with surrounding tissues (flip flop). It was noted that, based on literature reports, tumors of mesodermal origin (leiomyoma, spindle cell sarcoma, neurofibroma) may have the ability to concentrate Tc-99m DTPA.

Pulmonary tumor associated with diffuse bilateral lung uptake of bone imaging agent.

Radiogallium accumulated in a large cell carcinoma of the left lung. A bone scan in the patient showed bilateral intense uptake of Tc-99m MDP in the lung fields, as well as in the tibias, by an undefined mechanism

Nuclear medicine studies of aging—VII. Humeral deltoid tuberosity on bone scans and radiographs

Because of the occasional finding of increased deposition of bone imaging agent in the area of the humeral deltoid tuberosity, we analyzed both bone scans and radiographs to determine if there were age related correlations. Only 29% of patients of age 35 years or younger showed any radiographic evidence of deltoid tuberosity. This increased to 48% in the 36-64 y age group (and 46% in those of age 65 y and above). Bone scans (99mTc-MDP) of the humerus showed that 26% of individuals of ages 20-39 y had increased uptake in the deltoid tuberosity area. The figure was 21% of those in the 85-94 y age group. However, distribution between sexes in the 20-39 y age cohort was asymmetric (44% of males showed the bone scan finding, but only 15% of the females). We then reviewed cases that had shown the most prominent deltoid tuberosity on humeral radiographs. Thirteen of the 14 cases (93%) were males. Deposition of bone imaging agent in the deltoid tuberosity region was thus only slightly correlated with age (more common after age 35 y), but strongly correlated with sex (males more common) in all three major age groups (35 and under, 36-64, and 65 years and over). Possible interrelations with bone size and muscle mass were pointed out.

Intrahepatic lesions demonstrated to be hemangiomas after a ten-year lapse.

A 48-year-old man had multiple Intrahepatic lesions on both CT and liver scans. However, they were relatively unchanged from those detected 10 years previously. Blood pool imaging demonstrated that they were hemangiomas.

Recovery of Femoral Head Perfusion after Drainage of Septic Joint

A 64-year-old woman was febrile and had pain near the right hip. Blood cultures grew beta hemolytic streptococci. A bone scan showed reduced activity in the right femoral head and neck compared with the left femoral head and neck. She was treated with intravenous antibiotics and surgical decompression of a tense and bulging right hip joint. Five days later, a repeat bone scan revealed much of the femoral head activity to have returned. By day 20 after the initial bone image, there was intense activity throughout the femoral head and neck. Prompt relief of a distended hip joint can result in reperfusion of the femoral head and neck.