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[99m]Tc-MDP abdominal scintigraphy in a paediatric case of GI protein loss - a viable and simple alternate to HSA imaging
Iranian Journal of Nuclear Medicine. 2013; 21 (1): 40-43
in English | IMEMR | ID: emr-140403
ABSTRACT
A nine-month old male child presented with low-grade fever, loose stools and facial puffiness. Clinically patient was otherwise normal except for a firm liver on palpation. The laboratory tests revealed hypoproteinemia [both albumin and globulin] and iron deficiency anemia. Differential diagnosis considered were 1. Nephrotic syndrome, 2. Cystic fibrosis [in view of recurrent diarrhea and respiratory complaints] 3. Chronic liver disease, in view of firm palpable liver 4. Lastly protein losing enteropathy [PLE]. As biochemically patient revealed no positive results, PLE was suspected. For confirmation 99mTc-Methylene diphosponate [MDP] scintigraphy was found to be useful in the setting of non availability of 99mTc-HSA. MDP scan revealed abnormal minimal extravasation of tracer from bowel loops in right lower abdominal quadrant suggesting a diagnosis of PLE. According to the American Gastroenterological Association [AGA] in patients with iron-deficiency anemia who do have GI symptoms, the prevalence of celiac disease is higher and ranges from 10% to 15% which may be a plausible explanation in our patient. The diagnosis of PLE is most commonly based on the determination of fecal alpha-1 antitrypsin clearance. However the localization of gastrointestinal protein [GI] protein loss is possible by scintgraphic techniques alone, as was done in our case using [99m]Tc-MDP instead of conventionally used [99m]Tc-HSA
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Index: IMEMR (Eastern Mediterranean) Main subject: Pediatrics / Celiac Disease / Technetium Tc 99m Aggregated Albumin / Technetium Tc 99m Medronate / Anemia, Iron-Deficiency / Abdomen / Hypoproteinemia Type of study: Case report Limits: Humans / Male Language: English Journal: Iran. J. Nucl. Med. Year: 2013

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Index: IMEMR (Eastern Mediterranean) Main subject: Pediatrics / Celiac Disease / Technetium Tc 99m Aggregated Albumin / Technetium Tc 99m Medronate / Anemia, Iron-Deficiency / Abdomen / Hypoproteinemia Type of study: Case report Limits: Humans / Male Language: English Journal: Iran. J. Nucl. Med. Year: 2013