ABSTRACT
Hemangiomas are extremely rare tumors of the heart that may present with pericardial effusion, dyspnea, chest discomfort, palpitations, or syncope. Few published reports have highlighted the utility of 18F-fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET-CT) in the evaluation of cardiac lesions. We report a case demonstrating the utility of 18F-FDG PET-CT in a young man who presented with gross pericardial effusion and suspicion of metastatic carcinoma on fluid cytology.
ABSTRACT
BACKGROUND: Stomach wall uptake (SWU) of tracer in 99mTc-MIBI myocardial perfusion imaging (MPI) occasionally leads to imaging artifacts, thereby lowering the diagnostic accuracy. It is less-studied phenomenon for possible link with proton pump inhibitors (PPIs) intake. This prospective work looked for association of SWU with PPI intake and compared its incidence with H2 antagonists (H2A) users and patients not on either gastroprotective medication. METHODS: One hundred fifty-six patients undergoing one day stress/rest 99mTc-MIBI SPECT-MPI were distributed into four groups: control group (n = 48, not on any gastroprotective medication), PPI group (n = 47, on PPI treatment), H2A group (n = 19, on H2A therapy), and intervention group (N = 42, PPI discontinued for 3 days before MPI). Poststress planar images were analyzed for clinically relevant SWU. RESULTS: Clinically relevant SWU was seen in 36% of PPI group patients compared to 8% in the control group, 10.5% in the H2A group, and 9.5% in the intervention group, respectively, with statistically significant difference. Only 1/40 patients undergoing exercise stress showed clinically relevant SWU compared to 26/116 patients undergoing adenosine stress (P = .020). CONCLUSION: Patients on PPIs scheduled for vasodilator stress MPI may discontinue PPIs for 3 days, or replace with H2A to reduce the incidence of clinically relevant SWU associated with PPI therapy.
Subject(s)
Coronary Artery Disease/diagnostic imaging , Gastric Mucosa/metabolism , Histamine H2 Antagonists/therapeutic use , Proton Pump Inhibitors/therapeutic use , Radiopharmaceuticals/pharmacokinetics , Technetium Tc 99m Sestamibi/pharmacokinetics , Adult , Aged , Aged, 80 and over , Coronary Artery Disease/metabolism , Female , Humans , Male , Middle Aged , Myocardial Perfusion Imaging , Prospective Studies , Single Photon Emission Computed Tomography Computed TomographySubject(s)
Coronary Artery Disease/diagnostic imaging , Heart Ventricles/diagnostic imaging , Myocardial Perfusion Imaging , Radiopharmaceuticals , Technetium Tc 99m Sestamibi , Tomography, Emission-Computed, Single-Photon , Coronary Artery Disease/physiopathology , Coronary Circulation , Exercise Test , Female , Heart Ventricles/physiopathology , Humans , Middle AgedABSTRACT
A 71-year-old male patient with urothelial carcinoma of the bladder was referred for 99mTc-methylene diphosphonate bone scintigraphy to assess for skeletal metastasis. While the bone scan showed no abnormal skeletal uptake, tracer activity was detected in the extrarenal region of the left renal fossa on the planar image; single photon emission computed tomography-computed tomography (CT) demonstrated tracer pooling in the perirenal collection. In addition, the CT detected nontracer-avid parenchymal lung nodules and hypodense liver lesions consistent with metastatic disease. The perinephric urinary leak was drained by percutaneous drainage, confirmed by diuretic renography the following day.
