Myron L. Lecklitner

Musculoskeletal findings in Klippel-Trenaunay syndrome.

Klippel-Trenaunay syndrome is an angio-osteohypertrophy syndrome without deep arteriovenous malformations. Clinical manifestations consist of vascular nevi, varices, and bony and soft-tissue hypertrophy. On skeletal imaging, there was extensive radionuclide uptake in a massively enlarged right lower extremity.

Failure of quality control to detect errors in the preparation of technetium-99m disofenin (DISIDA)

Uptake of Tc-99m disofenin is so strongly hepatobiliary that striking appearance of radioactivity in the reticuloendothelial system (RES) is almost certainly caused by improper preparation of the disofenin kit. Four patients who received injections of Tc-99m disofenin demonstrated a pronounced RES biodistribution in addition to the expected hepatobiliary pattern. Since routine quality control testing had not forewarned us of this gross lack of radiochemical purity, Tc-99m disofenin kits were subjected to a variety of insults to elucidate the mechanisms of quality control failure. Assessment of radiochemical purity was conducted using instant thin-layer chromatography (ITLC) and two solvent systems. We concluded that both Tc-99m pertechnetate and Tc-99m sulfur colloid had been injected into the cold disofenin kit. Visual inspections were not reliable for verifying the final radiopharmaceutical product because of dilution of the sulfur colloid by pertechnetate. ITLC testing failed because the assay method being used at that time did not accurately assess the hydrolyzed fraction (colloidal component). Recommendations are made to preclude recurrence of the errors that occurred.

99m Tc-PIPIDA Cholescintigraphy in the Diagnosis of Gallbladder Disease

The efficacy of 99mTc cholescintigraphy in the diagnosis of gallbladder disease was studied in 116 patients. Sixty-one demonstrated gallbladder visualization (normal) and 55 had nonvisualization. In patients with acute abdominal pain, test sensitivity is 100%, specificity is 77%, and accuracy is 83% for the diagnosis of acute cholecystitis; no patient with gallbladder visualization had acute cholecystitis. Test sensitivity for any form of gallbladder disease is 66%, specificity is 82%, and accuracy is 71%; excluding patients with laboratory evidence of hepatobiliary disease, the predictability of acute or chronic cholecystitis increases to 100%. Cholescintigraphy demonstrated common bile duct patency in all eight post-cholecystectomy patients referred for evaluation of possible choledocholithiasis. Thus, gallbladder visualization with 99mTc-PIPIDA virtually excludes the diagnosis of acute cholecystitis, an abnormal test is a good predictor of gallbladder disease because of high specificity, and cholescintigraphy is extremely safe and simple to perform and may be used to demonstrate common bile duct patency.

Absence of gallium-67 avidity in diffuse pulmonary calcification

Diffuse pulmonary uptake by bone-seeking radiopharmaceuticals has been reported previously but, in the same patient, would pulmonary uptake of Ga-67 citrate yield clinically meaningful results? A patient with hypercalcemia and renal failure in whom bone scintigraphy demonstrated striking diffuse bilateral pulmonary uptake, but subsequent gallium imaging demonstrated no evidence of pulmonary uptake greater than body background, is discussed. We conclude that pulmonary uptake of gallium cannot be attributed to calcium deposition and should carry the same clinical significance in regard to inflammatory and malignant lesions as would be assigned to patients without pulmonary calcific deposits.

Bone scintigraphy and postoperative ureteropelvic urine extravasation

A case of severe urinary extravasation after renal pyeloplasty resulted in symptoms strongly suggestive of musculoskeletal origin. Bone scintigraphy revealed no findings relating to the skeletal system, but because of renal excretion of the tracer, the cause of the postoperative pain was revealed. The value of bone scintigraphy as a urinary tract diagnostic screening tool is probably underrated, even though at least 15% of studies fortuitously detect abnormalities of the urinary tract.

Computed tomography in acquired absence of thoracic pedicle.

A patient with an acquired absence of a thoracic pedicle is presented, and the contribution of CT examination is demonstrated. A brief anatomical and radiographic review of congenital and acquired absence of pedicles is provided.

Gallium-67 and pulmonary complications of amiodarone.

A 66-year-old white man with amiodarone pneumonitis is presented. The diagnosis was made with the aid of Ga-67 imaging, which is a sensitive method of detecting amiodarone pulmonary toxicity in patients with symptomatic pulmonary infiltrates on chest radiographs. Ga-67 Imaging is especially useful in distinguishing amiodarone pneumonitis from congestive heart failure.

Hepatic cavernous hemangioma: A potential pitfall during evaluation of gastrointestinal bleeding with 99mTc-labeled erythrocytes

The purpose of this report is to underscore one previously unreported hepatic parenchymal lesion detected during evaluation of occult lower gastrointestinal hemorrhage. In more than 90% of the patients harboring the lesion, the individual remains asymptomatic, requires no intervention, and closed biopsy is contraindicated: hepatic cavernous hemangioma. Whereas the list is expanding of normal and abnormal structures which can interfere with the interpretation of scintigraphic gastrointestinal bleeding studies accomplished with 99mTc-labeled erythrocytes, it is absolutely necessary to demonstrate intestinal transit of the activity, in order to discount detected activity in either non-hemorrhagic lesions or normal structures as the nidus of suspected bleeding.

Fortuitous findings of Tc-99m PIPIDA hepatobiliary scintigraphy.

Hepatobiliary scintigraphy using Tc-99m labeled radiopharmaceuticals is employed primarily for the diagnosis of acute cholecystitis and for demonstration of biliary tract patency. This procedure may also provide diagnostic information in the identification of unusual or atypical hepatobiliary disorders; frequently, this occurs as an incidental result of the test. We present five cases in which trauma, infection, or obstructive abnormalities were diagnosed fortuitously.

Bone imaging in the assessment of en bloc osteocutaneous autotransplantation

A patient is presented who sustained an avulsed portion of the mandible and all soft tissues of the floor of the oral cavity, requiring an autogenous en bloc transplant to replace the avulsed tissues. The clinical role of bone imaging in assessing the patency of the microvasculature and viability of the vascularized osteocutaneous graft is discussed, and the criticality of the time of image acquisition in prognosticating the success of the transplantation is emphasized.