Pneumonia can cause 111indium octreotide uptake

An 18-year-old woman underwent an (111)In octreotide scan for evaluation of a possible insulinoma. This showed mildly increased radiopharmaceutical uptake involving the right lung base. The patient reported a productive cough for 5 days before the octreotide scan. A chest radiograph was taken, which showed increased airspace opacification in the right lower lobe, corresponding to the uptake seen on the octreotide scan. After a course of oral antibiotics, the patient's chest symptoms improved and the radiograph opacification resolved, confirming the diagnosis of community-acquired pneumonia. This case stresses the need to correlate scan results with the patient's presentation and symptoms to avoid false-positive data.     

Tracheal compression by a normal aorta associated with right lung agenesis.

A case of tracheal compression by a normal aorta deviated to the right with a shift of the heart due to right lung agenesis is presented. The condition was diagnosed by chest fluoroscopy and corrected surgically. The increased mortality associated with right versus left lung agenesis may be due to tracheal compression by a normal aorta in some cases.     

An unusual case of a false-positive iodine-131 whole body scan in a patient with papillary thyroid cancer

A false-positive I-131 whole body scan (WBS) for lung uptake in a patient with papillary thyroid cancer, with replacement of his infiltrated esophagus with a left colon graft, is presented. The I-131 image, seen in the upper right lung field, was due to the contaminated colon graft lacking normal peristaltic movements, which was located in the right paramediastinal region. This finding was demonstrated by imaging the upper digestive tract with orally administered Tc-99m DTPA and by a barium x-ray.     

Unusual pattern of lung uptake of technetium-99m sulfur colloid seen on the liver scan of a patient with pulmonary tuberculosis

In evaluating alcoholic liver disease in a patient with pulmonary tuberculosis, a liver-spleen scan was performed that showed an unusual uptake of sulfur colloid in the lungs. There was diffuse uptake in the left lung and portions of the right lower lung with absent uptake in the right upper lobe and portions of the right lower lung corresponding to areas of pulmonary consolidation. A perfusion lung scan confirmed absent pulmonary arterial perfusion in these areas and a gallium scan demonstrated active infection there.     

Extensive F-18 FDG uptake in metastatic spindle cell carcinoma of the lung

A 77-year-old man with stage IIB squamous cell carcinoma of the lung underwent right upper lobectomy. One month later he was examined for right chest pain, dyspnea, cough, and weakness. A roentgenogram showed nondiagnostic diffuse opacification of his right lung cavity. An F-18 FDG positron emission tomographic (PET) study revealed extensive uptake in the right pleural area, left adrenal gland, right axilla, and soft tissues consistent with extensive local recurrence and metastatic disease. Biopsy of a right chest soft tissue lesion showed spindle cell carcinoma, a rare variant of squamous cell carcinoma.     

Uptake of 123I-MIBG in a hepatic hemangioma in the scintigraphic study of an adrenal gland lesion

A 60 year old symptom free female in whom a lesion in left adrenal gland was found by chance in a CT scan is presented. She also had increased serum and urine catecholamines levels. 123I-MIBG scintigraphy showed a non-physiological uptake in right adrenal gland that is still seen in the delayed image, with normal left gland. MRI confirmed the presence of a mass in the left adrenal gland suggestive of an adenoma and found a lesion in the right hepatic area at the level of the previously seen MIBG image. This lesion was labelled as a hemangioma and would explain the findings of the isotopic study with MIBG. It must be considered as a false positive for phaechromocytoma. The increased catecholamine serum and urine levels were due to drug interactions.     

Simultaneous occurrence of typical carcinoid and non-small-cell lung cancer in the same lung lobe: value of nuclear medicine

The present report demonstrates the usefulness of nuclear medicine in differentiating different pulmonary tumors. A 79-year-old woman presented with a suspicious peripherally located lesion of the right lower lobe in the costophrenic angle. During bronchoscopic evaluation, a centrally located intrabronchial lesion was found, which was positive on a subsequent In-111 octreotide examination. The histologic examination of this central lesion confirmed a typical bronchial carcinoid. The FDG PET examination revealed a high uptake just in the peripherally located lesion, which was then confirmed to be non-small-cell lung cancer. This is the first report of nuclear medicine methods evaluating simultaneous occurrence of a typical bronchial carcinoid and a non-small-cell lung cancer in the same lung lobe.     

Thallium-201 lung uptake in patients with chronic phase of myocardial infarction

To study pathophysiological significance of Tl-201 lung uptake in coronary artery disease Tl-201 lung uptake was studied in 159 patients with chronic phase of myocardial infarction. Tl-201 lung uptake images were collected after rest Tl-201 myocardial imaging. Tl-201 lung uptake was estimated by comparing maximal lung counts with maximal myocardial counts (thallium lung heart ratio: LHR). Good correlation between LHR and mean pulmonary artery wedge pressure (mPw) and between LHR and left ventricular ejection fraction (EF) were obtained, (mPw = 2.7 +/- 10.5 LHR r = 0.52 n = 102, p less than 0.001, EF = 84.9-52.2 LHR r = -0.61 n = 159, p less than 0.001). It was noted that Tl-201 did not accumulate uniformly through the lung field and usually maximal Tl-201 lung uptake was noted at the basal zone of the right lung. Tl-201 lung uptake in the upper zone of the right lung increased in proportion to the hemodynamic deterioration. Interesting differences were noted between Tl-201 lung uptake in patients with chronic phase of myocardial infarction and that in patients with acute phase of myocardial infarction. The prognosis and clinical status of patients with markedly increased Tl-201 lung uptake (LHR greater than 0.8) in chronic phase were more excellent than the patients with similar Tl-201 lung uptake in acute phase. Hemodynamic parameters in patients with markedly increased Tl-201 lung uptake (LHR greater than or equal to 0.8) in chronic phase were significantly better than in those in acute phase.(ABSTRACT TRUNCATED AT 250 WORDS)     

Perfusion lung scan in patients operated for transposition of the great arteries

Fifty perfusion lung scans were performed with Tc-99m albumin microspheres in 42 patients, 15 days to 12 years after corrective surgery for transposition of the great arteries. The scan was entirely normal in nine of 42 patients. Absence of left lung perfusion was observed in three patients and hypoperfusion of the left lung in 19 patients. Segmentary zones of hypoperfusion was visualized in 13 patients either in the right or left lung. A moderate right to left shunt was observed in eight cases. The absence or decrease in left lung perfusion was due to pulmonary vein occlusion in four patients, left pulmonary artery stenosis in two patients, and preferential right blood flow in one patient. Right to left shunt was due to dehiscence of the atrial patch in four patients.     

A case of increased 123I-IMP uptake in adenocarcinoma of the lung

It has been reported that delayed 123I-IMP lung scintigraphy shows a defect corresponding to the tumor with increased accumulation around the tumor, and that an increased accumulation is associated with atelectasis and inflammation. We presented a case of increased uptake of 123I-IMP in lung cancer. None of the other reported case of increased uptake in lung cancer, to our knowledge, occurred. A 55-year-old man had a 6 cm mass in the lower lobe of the right lung. Cytologic examination with a small curette diagnosed the case as an adenocarcinoma. The 123I-IMP scintigraphy was performed 24 hours after intravenous injection of 111 MBq of 123I-IMP. The 123I-IMP SPECT lung images showed an area of increased 123I-IMP concentration corresponding to the tumor mass. The patient's subsequent course was characterized by massive pleural effusion caused by extensive invasion to the pleura despite chemotherapy. He died about 2 months after the 123I-IMP scintigraphy. The right lung removed at necropsy confirmed that the area of high 123I-IMP concentration corresponded to the mass, which proved a poorly differentiated adenocarcinoma. One should note that there is an unusual case with high 123I-IMP uptake in lung cancer.     

Intrathoracic and intra-abdominal Tl-201 abnormalities seen on rotating raw cine data on dual radionuclide myocardial perfusion and gated SPECT.

PURPOSE: The lower thorax and upper abdomen are visualized during cardiac acquisition of rest Tl-201 and stress Tc-99m tetrofosmin gated SPECT. Thus, abnormal Tl-201 localization in these areas and in organs such as parts of the lungs, liver, spleen, and kidneys can be observed, including rotating raw cine data. MATERIALS AND METHODS: Other than cardiac images, the authors retrospectively reviewed Tl-201 rotating (raw data) images of 235 patients. Abnormal findings in the lungs, liver, spleen, and kidneys were identified that correlated with the patients' clinical information; radiographic findings, including computed tomography and ultrasonography of the abdomen; other scintigraphic studies; and laboratory findings. RESULTS: In 53 patients, 54 abnormalities were detected. Intrathoracic abnormalities included focal areas of increased uptake, one in the right lower lung and another in the right upper lung that confirmed lung cancer, in 2 patients; diffuse uptake in both lungs in 11 patients; photopenia in the lung bases, which had resulted from pleural effusions, in 3 patients; and abnormal right liver configuration caused by elevation of the right hemidiaphragm in 1 patient. Of the intra-abdominal abnormalities, 12 patients with splenomegaly were identified. Six patients had focal areas of increased uptake in the gastric area. Nonvisualization of one kidney resulted from a congenitally absent right kidney in 1 patient, from right nephrectomy in 1 patient, from end-stage renal disease in another, and from a lower position of the left or right kidneys in 5 patients. Small and decreased uptake of both kidneys resulted from end-stage renal disease in 1 patient. Small and decreased uptake of one kidney was noted in 1 patient with renal scarring, in 1 patient with a renal stone, in 3 patients with chronic pyelonephritis, and in 5 patients with renal cyst(s). CONCLUSIONS: Discernible intrathoracic and intra-abdominal abnormalities using rotating raw cine data from imaging in three-dimensional displays include diffuse or focal pulmonary uptake, pleural effusion, elevation of a hemidiaphragm, splenomegaly, increased uptake in the gastric area, renal abnormalities including absent or small kidneys, end-stage renal disease, renal scarring, renal cyst(s), and lower position of a kidney. The incidental finding of such abnormalities may prompt further clinical investigation.     

Negative lung thallium-201 uptake in right ventricular infarction

In a case of right ventricular infarction, a negative lung image was observed on the resting thallium-201 scan, with a pulmonary activity much lower than the surrounding background. The myocardial image showed only a moderate inferior hypoactivity and the left ventricular ejection fraction was normal. This seems to be related to right ventricular failure with normal left ventricular function. It represents the opposite mechanism to the increased pulmonary thallium uptake commonly seen in severe left ventricular impairment.     

A case of three synchronous primary tumors demonstrated by F-18 FDG PET

We present an F-18 FDG PET scan which demonstrates 3 synchronous primary malignancies. The patient is a 61-year-old man who presented with weight loss and dysphagia. He was initially diagnosed with squamous cell carcinoma of the midesophagus, and was then found to have an adenocarcinoma in the right lung. A staging PET scan additionally showed increased left tonsillar uptake. Subsequent biopsy confirmed squamous cell carcinoma of the left tonsil. The demonstration of 3 synchronous primaries by PET is probably rare.     

Bone scan appearance in aggressive osteogenic sarcoma with pleural, lung, bone, and soft-tissue metastases

A 40-year-old woman presented with a known case of osteogenic sarcoma of the right leg and underwent below-the-knee amputation. The preoperative workup was negative for distant metastases, and the patient was followed regularly. Two years later she developed dyspnea and chest pain. Computed tomography revealed diffuse left lung metastases with pleural involvement and nodular metastases in the right lung. Tc-99m methylene diphosphonate whole-body bone scanning revealed the amputated right leg with a clean stump but with widespread metastases in the right thigh involving soft tissue and bone, and the pelvis, left femur, and skull. In addition, diffuse left lung metastases involving both parietal pleura and lung parenchyma were seen. Tc-99m methylene diphosphonate uptake has been observed in the soft tissue and lungs in patients with osteogenic sarcoma but is rarely observed in practice with this degree of aggressiveness.     

FDG-PET findings in barium aspiration

A 47-year-old man had nasopharyngeal carcinoma (NPC). He received radiotherapy 10 years ago and was cancer-free after the treatment. However, diplopia occurred 1 year ago and became more progressive recently. An FDG-PET scan was performed to rule out the possibility of recurrence. No abnormal FDG uptake was demonstrated in the head and neck. However, an irregular area of increased FDG uptake was noted in the right lower lung. The plain chest x-ray showed barium retention in the same area, which might have resulted from aspiration of barium during gastrointestinal barium examination 2 years ago. A follow-up chest x-ray showed no apparent change and there was no evidence of metastases in the lung 6 months later.     

Increased activity on In-111 octreotide imaging due to radiation fibrosis

Indium-111 octreotide scintigraphy is a useful investigation in the diagnosis and staging neuroendocrine or nonendocrine malignancies such as carcinoid, granulomas, small cell lung cancer, medullary thyroid carcinoma, and others. Tumors with large numbers of somatostatin receptors can be accurately imaged and this can be useful in guiding treatment. Although uncommon, false-positives studies have been reported and often the cause is unexplained but assumed to be a high number of somatostatin receptors in other pathology. We present a case with increased uptake resulting in a scan due to pulmonary fibrosis.     

Influence of increased 201Tl lung uptake on the myocardial viability of the patients with dilated cardiomyopathy under congestive heart failure]

Influence of increased 201Tl lung uptake on the myocardial viability was studied in 15 patients with dilated cardiomyopathy under congestive heart failure. Rest and 4 hours delayed 201Tl SPECT were obtained. At the same time anterior planar images were collected. In 10 patients of 15 patients 201Tl lung heart ratio in SPECT (LHR) was larger than that in planar images. Maximal 201Tl lung uptake was noted at the lower left lung adjacent to the heart. In the delayed images 201Tl lung uptake diminished. In 10 patients the value of LHR in the delayed images was less than 0.5. By comparing initial images with delayed images it was proved to be difficult to determine the myocardial margin adjacent to the increased 201Tl lung uptake. In 2 patients lateral defects were concealed by the increased 201Tl lung uptake. In the remaining patients lateral wall was similar to the hypertrophic myocardium. The effect of scatter due to the increased 201Tl lung uptake was noted in the neighboring myocardium. In most cases %201Tl uptake in the septum was relatively depressed by increased %201Tl uptake in the lateral wall. In the delayed images pseudo-redistribution was noted in the septum. Mean value of differences in %201Tl uptake between initial and delayed images was 8 (2-15)%. It was concluded that in case of increased 201Tl lung uptake SPECT could not accurately estimate myocardial viability by initial images and delayed images were necessary for precise estimation.     

Unilateral pulmonary metastases from Ewing's sarcoma shown in a technetium-99m-methylene-diphosphonate bone scan

A 32-year-old man with a history of painful swelling of the right ankle underwent bone scintigraphy, which showed increased uptake in the right ankle and also unexpected diffuse uptake throughout the right hemithorax. A single photon emission tomography scan performed after the intravenous injection of 740 MBq of technetium-99m methylene-diphosphonate ((99m)Tc-MDP) showed abnormal uptake throughout the right lung. Computed tomography (CT) revealed a large mass in the right lower lobe. CT-guided biopsy of this mass led to a diagnosis of metastatic Ewing's sarcoma. Although lung uptake on bone scans has been noted in various occasions (such as: pulmonary alveolar microlithiasis, Pneumocystis carinii pneumonia, and various tumoral lesions), increased uptake of (99m)Tc-MDP in lung metastases of Ewing's sarcoma has not been reported according to our knowledge until now. We report such a case.     

Uptake of Tc-99m MAA by the liver during a thromboscintigram/lung scan

A young man with a swollen left leg was referred to us for a thromboscintigram/lung scan. The unexpected visualization of the liver during the flow study after intravenous injection of Tc-99m MAA into the dorsal veins of both feet provided the clue to his underlying problem. He was shown to have extensive venous collateralization in the left pelvis, and to a lesser degree on the right, due to a large pelvic mass. This was shown to consist of metastases from a previously treated testicular carcinoma. Venous drainage from the legs was shunted into the mesenteric circulation, which them emptied into the portal vein, thereby carrying the radiopharmaceutical to the liver. No uptake was seen in the spleen.     

Diagnostic value of TL-201 lung uptake is dependent on measurement method

BACKGROUND: Increased lung uptake during exercise thallium 201 single photon emission computed tomography is related to left ventricular dysfunction and extent of coronary artery disease (CAD). We studied the influence of the lung region of interest (ROI), used to quantify Tl-201 lung uptake, on the diagnostic value of the lung-to-heart uptake ratio (LHR) in detecting CAD with Tl-201 myocardial single photon emission computed tomography. METHODS AND RESULTS: We retrospectively studied 152 consecutive patients referred to our center for stress Tl-201 scanning. Of these, 116 had proven multivessel CAD and 36 had either normal findings on coronary angiogram or a low likelihood (<5%) of CAD. Poststress quantitative analysis was performed from a 4 x 4-pixel ROI over the hottest myocardial region, an 8 x 8-pixel left lung ROI, an 8 x 8-pixel right lung ROI, and a manual ROI encompassing the whole right lung. The LHR was calculated for each lung ROI. Right LHR (R-LHR) provided the best interobserver and intraobserver reproducibility. R-LHR and total R-LHR values were significantly higher in patients with CAD. Only history of myocardial infarction significantly influenced the R-LHR measurement. CONCLUSIONS: The methodology of LHR measurement significantly influences the clinical contribution of Tl-201 lung uptake evaluation. Optimal reproducibility and diagnostic accuracy are provided by a right lung ROI.