Leo Ackerman

Case report 488

Address reprint requests to: Leo Ackerman, M.D., Nuclear Medicine Service (115), Hines VA Hospital, Hines, I1. 60141, USA to hospital because of progression of the pain. Physical examination revealed an ill-defined firm mass, about 8 cm in diameter over the lateral aspect of the left scapula. Motion of the shoulder was limited due to the pain. No evidence of fever, leukocytosis or abnormal blood chemical findings was elicited. A radiograph of the left shoulder showed soft tissue swelling and amorphous calcification at the

Malignant fibrous histiocytoma metastatic to the thyroid gland.

Despite frequent cancer metastases to the thyroid gland demonstrated at autopsy, finding of thyroid metastasis in clinical practice is rare. Malignancies most commonly metastasizing to the thyroid are malignant melanoma and carcinoma of the breast, kidney, and lung. Very little is known about thyroid metastases caused by sarcomas. Of these, malignant fibrous histiocytoma (MFH) is one of the most common in adults, with a high rate of metastases. A case of clinically significant thyroid metastasis from primary MFH involving the thigh visualized on I-123 thyroid imaging is reported.

The effects of acute hypertriglyceridemia and high levels of free fatty acids on left ventricular function

The effects of acute hypertriglyceridemia and of high levels of free fatty acids on the left ventricular ejection fraction were studied by radionuclide ventriculography in 20 subjects with and without coronary artery disease. An infusion of approximately 125 ml of a 20% fat emulsion over 25 minutes resulted in an increase of plasma triglycerides to the mean of 820 mg/dl and a fall of the left ventricular ejection fraction from the baseline mean of 62% to 58% (p less than 0.05). Ninety minutes after the intravenous administration of 5000 units of heparin, plasma free fatty acids rose to the mean of 4.6 mmol/L and the mean left ventricular ejection fraction increased to 69% (p less than 0.001). The observed changes in blood lipids were not associated with clinical or ECG evidence of myocardial ischemia. We conclude that acute hypertriglyceridemia causes slight depression of left ventricular performance, while high levels of free fatty acids augment it. However, neither hypertriglyceridemia per se nor its rapid conversion to free fatty acids are likely to cause angina in stable patients with coronary artery disease.

Case report 836

We present a case of PLB found in the sacrum in an HIV-seropositive patient who had low back pain radiating to the lower extremities. To the best of our knowledge this is the first report of this kind. Multiple imaging techniques, including MRI, could not reliably differentiate between neoplasm and infection. Both processes were considered since the patient was not only HIV-seropositive but also was an intravenous drug abuser and had a history of TB. The biopsy revealed diffuse large cell lymphoma typical of AIDS patients. The unusual location of PLB in our patient is a characteristic feature of lymphoma in patients with AIDS and our case should increase awareness among clinicians and radiologists of this possibility.

Effect of acute postinfusion lipemia and free fatty acids on myocardial contractility: Assessment with radionuclide ventriculography

Equilibrium gated radionuclide ventriculography was used to evaluate the effect of intravenous fat-emulsion overload and excess of free fatty acids (FFA) on left ventricular ejection fraction (LVEF) in 20 patients with and without coronary artery disease (CAD). Fifteen of these patients had normal (>50%) baseline LVEF and 5 had low (<50%) baseline LVEF. From 100 to 150 ml of 20% artificial fat emulsion (Liposyn) was infused over 20–25 min. At the end of the infusion, triglyceridemia reached 820±220 mg% and left ventricular ejection fraction decreased from baseline 62±19% (mean±SD) to 58±16% (P<0.05, paired t-test). After completion of Liposyn infusion, 5,000 U of heparin was administered intravenously and monitoring of LVEF was continuod. One and one-half hours following heparin administration, plasma FFA levels reached 3.7+2.0 mmol/l and LVEF rose to 69±19% (P<0.001, paired t-test). Our data indicate that acute intravenous fat overload can suppress and high pathophysiologic levels of FFA can increase LVEF. This effect is more uniform and statistically more reliable in patients with normal LVEF. The study failed to demonstrate any significant difference in the effect of this pharmacologic intervention between patients with and without CAD.

Positive iodine-131 6 beta-iodomethyl-19-norcholesterol (NP-59) adrenal images can precede return of adrenocortical function after o,p' DDD treatment

A patient with bilateral adrenal hyperplasia, due to the ectopic adrenocorticotrophic hormone (ACTH) syndrome, received a 3-month course of treatment with 1,1 dichloro-2(o-chlorophenyl)-2-(p-chlorophenyl)ethane (o,p‘ DDD), which caused adrenal hypofunction requiring steroid therapy. Eleven months later, Cushings syndrome recurred. His CT scan showed a left adrenal gland that was enlarged and a normal-sized right adrenal gland. However, the NP-59 image showed increased uptake by both glands. Venous effluent was sampled from each adrenal vein. The plasma cortisol level from the left gland was 1392 ng/ml, and that from the right gland was 667 ng/ml. The latter value was not significantly different from the values obtained at peripheral sites (517–744 ng/ml). In the course of recovery from o,p’ DDD damage, the ability of the adrenal gland to take up NP-59 may be restored before the return of its blosynthetic and secretory functions. Serial NP-59 adrenal images can anticipate the recurrence of Cushings syndrome after adrenolytic therapy, thereby permitting early retreatment.