Shiv M. Gupta

Klippel-Trenaunay-Weber Syndrome with Recurrent Pulmonary Embolism

A man with Klippel-Trenaunay-Weber syndrome had worsening pulmonary hypertension secondary to recurrent multiple pulmonary embolism despite anticoagulation. Pulmonary thromboendarterectomy was done. However, the patient expired 10 days after surgery due to another bout of pulmonary embolism from his right arm or right chest wall.

Various presentations of postcholecystectomy bile leak diagnosed by scintigraphy

Hepatobiliary scintigraphy is an established method for the diagnosis of a bile leak from the biliary system. A bile leak should be considered in any patient after cholecystectomy who has unexplained abdominal pain after operation. Three patients with bile leak diagnosed by scintigraphy are described, one of whom had an unusual pattern of hepatic subcapsular collection of the bile. The second patient had a bile leak through the postsurgical drainage tube, whereas the third patient had a more typical pattern of leakage into the peritoneal cavity.

Usefulness of SPECT in the early detection of avascular necrosis of the knees.

Single photon emission computerized tomography (SPECT), was performed on a female with an acutely painful knee. She had been on corticosteroids just before the onset of symptoms. Radiographs and planar scintigraphic views of the knees were unremarkable. SPECT images of the knees were instrumental in the diagnosis of avascular necrosis of the knee. The cases illustrates the usefulness of SPECT in the early detection of avascular necrosis of the knees.

Scintigraphic Evaluation of Polyostotic Fibrous Dysplasia

Bone scintigraphy is a sensitive imaging modality for detecting early lesions and polyostotic involvement in fibrous dysplasia. Common findings include multiple areas of focal uptake that are often unilateral and typically involve the ribs, tibia, femur, and craniofacial bones. A knowledge of various skeletal manifestations of fibrous dysplasia is helpful to distinguish it from Pagets disease, osteoblastic metastasis, and fractures. Several recent cases representing varying involvement of fibrous dysplasia are presented and the literature is reviewed.

Visualization of hepatic metastases of medullary thyroid carcinoma on Tc-99m MDP bone scintigraphy.

A 35-year-old man with a history of medullary carcinoma of the thyroid underwent a whole-body bone scan for chest wall pain. Extensive irregular radionuclide uptake was observed in hepatic metastases in both lobes, later confirmed on CT scan. A case of technetium-99m MDP uptake in hepatic metastases from medullary carcinoma of the thyroid is presented and the literature is reviewed.

Brain Death: Confirmation by Radionuclide Cerebral Angiography

Dynamic radionuclide cerebral angiography was performed in 14 patients with suspected brain death. In 10 of 14 patients, no intracranial arterial perfusion was demonstrable, thus confirming brain death. In four patients, faint venous activity was seen in the sagittal sinus only. All these patients also eventually died. Radionuclide cerebral angiography provides a simple and noninvasive means to confirm brain death in critically ill patients maintained on life support systems particularly when an electroencephalogram and four vessel contrast angiography may be either impractical or equivocal.

Demonstration of subclinical inguinal hernia by peritoneal scintigraphy

Continuous ambulatory peritoneal dialysis is a reliable and practical method of treatment for chronic renal failure. However, it may occasionally be complicated by abdominal and inguinal hernias. Radionuclide peritoneal scanning may detect their presence even before they become clinically evident. The following case shows the unique contribution of peritoneal scintigraphy in establishing the diagnosis of a subclinical inguinal hernia in a patient on CAPD, thus leading to its effective management.

Aberrant cerebrospinal fluid pathway. Detection by scintigraphy.

Radionuclide cisternography is routinely performed for assessment of normal and abnormal pathways and the hydrodynamics of cerebrospinal fluid (CSF). An unusual case of a woman in whom cisternography provided the diagnosis of an iatrosenic spinopleural fistula with a large CSF collection in the pleural cavity, following surgical resection of a vertebra for a malignant tumor is presented.

Scintigraphic Evaluation of Bile Dynamics Before and After Endoscopic Sphincterotomy

Endoscopic sphincterotomy has been used for the treatment of many biliary disorders, including extraction of obstructing common bile duct stones. Manometric studies of the sphincter of Oddi and the common bile duct have shown a marked decrease in biliary tract pressures after sphincterotomy. A prospective study of 12 patients with intact gallbladders using hepatobiliary imaging before and after sphincterotomy was performed to assess changes in bile dynamics. Nonfilling of the gallbladder occurred in 9 of the 12 patients after sphincterotomy, indicating significant alteration of bile flow. Such changes in bile dynamics may have serious implications in patients selected for medical dissolution of gallstones. It may also adversely affect specificity of cholescintigraphy in diagnosing acute cholecystitis.

Scintigraphic detection of a disseminated synovial lymphoma in a postrenal transplant patient.

Post-transplant lymphoproliferative disease is a recognized complication of immunosuppressive therapy, however, articular lymphomas involving the synovlum are very rare. Disseminated synovial lymphoma of the knee with hepatic involvement in a patient after renal transplant was suggested on bone/gallium scintigraphy and confirmed by synovial biopsy. Gallium scanning thus was instrumental in the evaluation, staging, and proper treatment of this rare condition.