John M. Bauman

Organizing hematoma of the thigh : multiple imaging techniques

A chronic, organizing hematoma of the thigh was imaged by multiple techniques. A remote history of trauma was noncontributory. The lesion was located by radiographs. Nuclear medicine studies showed no increased blood supply to the lesion but indicated that it was calcifying and did extend proximally. Ultrasound and CT studies could be variously interpreted to represent either a solid- or a fluid-filled lesion. An angiogram added little useful information. A differential diagnosis of an unexplained traumatic lesion vs a soft tissue tumor was made and surgery was performed. An organizing hematoma was excised.

Nonvisualization of the liver on a Tc-99m sestamibi parathyroid scan.

Tc-99m sestamibi images were acquired in a 62-year-old woman with an elevated parathyroid hormone level to rule out primary hyperparathyroid disease. Three areas of increased activity were noted in the neck, which were shown to be parathyroid adenomas by subsequent ultrasound. Incidentally noted on planar images was a lack of normal liver activity. Comparison with CT images of the abdomen revealed ascites and multiple large cystic lesions within the liver and kidneys consistent with autosomal-dominant polycystic kidney disease. To our knowledge, this is the first report of nonvisualization of the liver on a Tc-99m sestamibi scan.

Conceptual plan to link nuclear medicine and the MDIS radiology PACS

The Medical Diagnostic Imaging Support System (MDIS) is a project to install PACS systems at several medical sites in the military. The configuration calls for links to nuclear medicine in the near future but to date no definite system has been devised. This presentation describes a scenario in which a nuclear medicine department acts as a mini-PACS system with a direct link to the larger parent PACS system. The advantage of this approach is that it allows greater specialization at the workstation than is presently configured into the MDIS PACS system. Also large data sets can be reviewed and manipulated without slowing down the flow of images in the parent PACS. Only processed and formatted images are sent to the parent PACS system. Several problems exist in interfacing a nuclear medicine service with the MDIS PACS system and these are discussed.

Pseudodislocation of the glenohumeral joint diagnosed by bone scintigraphy

A three-phase bone scan was performed to examine right upper extremity pain in a 70-year-old woman suspected of having reflex sympathetic dystrophy. The patient was chronically anticoagulated for atrial fibrillation. The first two phases demonstrated no pertinent findings. Delayed imaging revealed a widened glenohumeral joint on the right with downward displacement of the humeral head. Subsequent radiographs confirmed pseudodislocation and laboratory evaluation revealed an elevated prothrombin time. Aspiration of the right glenohumeral joint yielded 60-70 cc of bloody fluid and resulted in prompt relief

The last surviving wall.

A total of 66 patients with advanced coronary artery disease (CAD) and 36 with dilated cardiomyopathies (DCM) with ejection fractions less than 20% were analyzed retrospectively to establish patterns of wall motion in each of four quadrants on standard left anterior oblique gated radionuclide ventriculograms. In both disease states the best preserved wall motion was found in the basal free wall quadrant of the left ventricle. The two terminal disease states could not be differentiated on the basis of wall motion patterns.

Profound xenon-133 trapping in left main bronchus. Obstruction by necrotic tumor.

Squamous cell carcinoma of the esophagus eroded into the central airway with production of left main bronchus occlusion and aspiration pneumonia of the right lower lobe.

The place of liver-spleen scanning in the workup of giant secondary cysts of the spleen.

An unusual, benign lesion of the spleen, the giant secondary cyst can be diagnosed by many imaging modalities, but the most helpful single test may be the liver-spleen scan. This study allows intelligent preoperative planning and postoperative assessment when splenic salvage is contemplated. Two cases illustrate this point.