Scintigraphic findings in a type 1 biliary atresia

Biliary atresia is a significant cause of neonatal jaundice that needs differentiation from neonatal hepatitis. Early identification of biliary atresia is important as surgical intervention is required. A hepatobiliary scan can help in the diagnosis of biliary atresia. Scintigraphic findings in a rare type of biliary atresia are described here to serve as a guide to other nuclear medicine physicians. Type 7 biliary atresia, which has an atretic common bile duct only, appears as persistent radiotracer activity in the gallbladder with no tracer activity in the intestines.

Silent parathyroid adenoma mistakenly interpreted on FDG-PET as thyroid cancer metastasis in a patient with elevated thyroglobulin and negative I-131 whole body scan and removed by radioguided minimally invasive surgery.

Detection of recurrent and metastatic thyroid cancer remains a considerable challenge in patients presenting with rising thyroglobulin levels but with negative I-131 whole body scintigraphy. Such is the case in this patient with follicular thyroid cancer in whom subsequent FDG PET scanning showed a solitary hypermetabolic cervical lesion. With definitive management and multidisciplinary approach in mind, radioguided surgical excision came into play through the use of Tc-99m sestamibi, leading to successful removal of the lesion. Histopathology, however, revealed a parathyroid adenoma. This highlights the importance of considering differential diagnoses in apparent cases of recurrence to avoid potential pitfalls.