Lung Metastasis From Prostate Cancer Revealed by 18F-FDG PET/CT Without Osseous Metastasis on Bone Scan.

A 54-year-old man, a case of prostate cancer, underwent radical prostatectomy and hormone therapy. Elevated prostate-specific antigen level developed 7 years later, but pelvic MRI and bone scan revealed negative results. Radiotherapy was performed under the suspicion of local recurrence but in vain. F-FDG PET/CT performed 1 more year later showed 3 FDG-avid lesions in the right lung and mediastinum. Lung and lymph node metastases were proved with video-assisted thoracoscopic surgery. Bone scan remained negative at that time.

Dipyridamole Tl-201 myocardial single photon emission computed tomography in the functional assessment of anomalous left coronary artery from the pulmonary artery.

Anomalous origin of the left coronary artery from the pulmonary artery is a rare congenital heart disease. Without surgical correction, most patients with this anomaly die during infancy from myocardial infarction and heart failure, with a mortality rate reported to be greater than 90% by 1 year of age. Some patients with significant collateral circulation from the right coronary artery may remain asymptomatic and survive into adulthood, but they usually develop progressive left ventricular dysfunction. The detection of myocardial ischemia in these patients is important to identify viable myocardium at risk for irreversible damage. We present 1 such case in which dipyridamole Tl-201 SPECT myocardial perfusion imaging played an important role in the decision-making process and was shown to be useful for the evaluation of the surgical result.

Neutropenic colitis with cecal perforation during antithyroid therapy.

Neutropenic colitis, characterized by neutropenia plus cecal and ascending colon inflammation, is a rare complication of chemotherapy in hematological malignancies and, less commonly, of medication used to treat other diseases (e.g., hyperthyroidism). We report a case of neutropenic colitis with cecal perforation in a 44-year-old woman treated with methimazole for hyperthyroidism. The patient had received subtotal thyroidectomy for hyperthyroidism in 1984 and recurrent hyperthyroidism was found in 1993. She was then treated with methimazole for almost 3 months, when sustained fever, diarrhea, weakness, and progressive abdominal pain developed. Due to the findings of peritonitis and neutropenia, she underwent emergent laparotomy. During the operation, chronic ulceration of the cecum with perforation was found and resection of the ileocecal segment and ileostomy were performed. Three months later, closure of the ileostomy with anastomosis of the ileocolostomy was performed. Her condition was stable during 9 years' follow-up. In conclusion, neutropenic enterocolitis has a broad spectrum of clinical presentations that require alertness in patients with neutropenia. When detected late, it may lead to bowel perforation and even mortality.