Robert J. Lull

Ventricular aneurysm due to cardiac sarcoidosis with surgical cure of refractory ventricular tachycardia

Abstract The case of a 22 year old Negro man with sarcoidosis proved by biopsy to involve lung, liver and myocardium is reported. The electrocardiogram showed typical changes of an anterolateral wall myocardial infarction, and the patient had multiform premature ventricular contractions and episodes of ventricular tachycardia which were unresponsive to treatment with steroids and currently available antiarrhythmic agents. Aneurysm of the left ventricular apex—the size of a tennis ball—was demonstrated by angiocardiography, and surgical resection provided dramatic improvement of the ventricular arrhythmias. This is the third reported case of ventricular aneurysm due to sarcoid, and the first case to be diagnosed clinically and treated successfully by surgical resection at open heart surgery. Ventricular aneurysm, regardless of origin, may present with refractory ventricular tachycardia, which can be successfully treated by surgical excision of the aneurysm.

Radionuclide evaluation of lung trauma

Nuclear medicine imaging procedures can play a significant role in evaluating the pulmonary complications that are seen in trauma patients. A quantitative method for measuring increased pulmonary capillary permeability that uses Tc-99m HSA allows early diagnosis of acute respiratory distress syndrome (ARDS) and accurately differentiates this condition from pneumonia or cardiogenic pulmonary edema. This technique may be of great value in following the response to therapy. The use of 133Xe to diagnose inhalation injury remains an important diagnostic tool, particularly at hospitals with specialized burn units. Regional decreases in ventilation-perfusion images reliably localize aspirated foreign bodies. Radionuclide techniques that are used to demonstrate gastropulmonary aspiration remain controversial and require further clinical evaluation. Pulmonary perfusion imaging, although nonspecific, may provide the earliest clue for correct diagnosis of fat embolism, air embolism, contusion, or laceration. Furthermore, the possibility of perfusion abnormality due to these uncommon conditions must be remembered whenever trauma patients are evaluated for pulmonary thromboembolism with scintigraphy. Occasionally, liver or spleen scintigraphy may be the most appropriate procedure when penetrating chest trauma also involves these subdiaphragmatic organs.

Tc-99m sestamibi myocardial imaging at rest for evaluation of cocaine-induced myocardial ischemia and infarction.

Many clinical cases of cocaine-induced myocardial infarction have been reported in the literature. Of the reported cases, patients tend to be young (in the third decade of life), chronic abusers with myocardial infarction typically involving the anterior left ventricular wall. This case report demonstrates the usefulness of two-phase (symptomatic and asymptomatic) Tc-99m sestamibi myocardial imaging at rest for definitive diagnosis of cocaine-induced myocardial ischemia and infarction.

Feasibility of Meckel's scan after RBC gastrointestinal bleeding study using in-vitro labeling technique.

The authors report a successful Meckels scan performed 26 hours after a labeled RBC study using a commercial in-vitro labeling kit, UltraTag® (Mallinckrodt Medical, Inc., St. Louis, MO). No abnormal alteration of Tc-99m distribution was observed as would be seen if an in-vivo RBC labeling technique was used. This case demonstrates that it is feasible to perform an in-vitro labeled RBC study for acute gastrointestinal bleeding in pediatric patients and to follow-up with a Meckels scan if it is necessary for diagnostic confirmation.