Spontaneous Ureteral Rupture During a 99mTc-Mercaptoacetyltriglycine Renal Scan.

After therapeutic pelvic radiation for malignancy such as prostate cancer, patients are at greater risk for spontaneous ureteral rupture. Bladder outlet obstruction and other more proximal causes of obstruction also exacerbate this vulnerability. Here we present a case of spontaneous ureteral rupture during a 99mTc-mercaptoacetyltriglycine nuclear renal scan secondary to Foley catheter obstruction in a 73-y-old man with a prior ureteral reimplantation procedure. Prompt detection of Foley catheter malfunction could potentially prevent such adverse events.

Incidentally discovered type 1 split cord malformation in an adult patient.

Split spinal cord syndrome (SCM), an entity of spinal dysraphisms, occurs rarely in adults and is associated with tethered cord syndrome, which commonly presents with back pain. Besides clinical findings, neuroimaging by Magnetic resonance imaging or computed tomography is needed for diagnosis. We report a case of a previously healthy 51-year-old man who presented for right upper abdominal quadrant pain. A computed tomography scan of the abdomen and pelvis incidentally discovered the diagnosis of type 1 SCM. This case highlights that SCM can remain asymptomatic throughout life to be diagnosed at one point by neuroimaging. Whenever no clinical complications exist, no surgical intervention might be indicated.

Cholescintigraphy for Differentiation of True Duodenal Obstruction from Pseudo Obstruction.

Small-bowel obstruction is a fairly common cause of abdominal pain. Differentiating between true duodenal obstruction and pseudo obstruction is important given differing treatment strategies. Here, we present augmentation of a hepatobiliary scan with a small amount of oral liquids and delayed imaging to differentiate between these two entities.

Incidental Detection of Synchronous Medullary Thyroid Carcinoma with Bilateral Adrenal Pheochromocytoma on Iodine-123 Metaiodobenzylguanidine Scintigraphy, Leading to Diagnosis of Multiple Endocrine Neoplasia 2A.

We report a case of a 29-year-old female with the family history of medullary thyroid carcinoma (MTC) presenting with hematuria and tachycardia, who was found to have bilateral adrenal masses on abdominal computed tomography and biochemical testing compatible with pheochromocytoma. Iodine-123 (I-123) metaiodobenzylguanidine (MIBG) scintigraphy for preoperative planning prior to planned adrenalectomy revealed incidental synchronous unifocal MTC, along with expected bilateral adrenal pheochromocytomas. Pathology confirmed these findings, and subsequent genetic testing confirmed a rearranged during transfection proto-oncogene mutation on exon 11, confirming the clinical diagnosis of multiple endocrine neoplasia 2A (MEN 2A). The unexpected incidental finding of synchronous MTC highlights the importance of considering MEN in the differential diagnosis when encountered with newly diagnosed pheochromocytoma and highlights the utility of I-123 MIBG scintigraphy in diagnostic workup of newly diagnosed pheochromocytoma.

Dumbbell Gallbladder Cholecystitis on Tc-99m Diisopropyliminodiacetic acid Hepatobiliary Imaging.

We present a case of a 79-year-old immunocompromised female admitted for abdominal pain and sepsis, who had an abdominal computed tomography (CT) showing distal gallbladder fundus wall thickening, pericholecystic edema, and a right posteroinferior hepatic abscess. Subsequent hepatobiliary scintigraphy with Tc-99m diisopropyliminodiacetic acid showed gallbladder filling of the proximal gallbladder fundus, yet no radiotracer filling of the distal gallbladder fundus. Further correlation with the initial CT showed a partial gallbladder stricture and a resultant altered morphology resembling a dumbbell-shaped gallbladder. Percutaneous cholangiogram also confirmed this dumbbell morphology. Nonfilling of radiotracer into the distal end of the dumbbell gallbladder correlating with CT findings of focal gallbladder inflammation indicated that there was a focal inflammation suggesting a distal dumbbell gallbladder cholecystitis. This case demonstrates a unique finding of focal inflammatory pathology involving an anatomic variant - the dumbbell-shaped gallbladder, and the challenges this anatomic variant presents in hepatobiliary scintigraphy image interpretation.

Extramedullary Plasmacytoma of the Gallbladder Detected on Fluorine 18-fluorodeoxyglucose Positron Emission Tomography/Computed Tomography.

Extramedullary plasmacytoma is rare in patients with diagnosed multiple myeloma. Soft tissue plasmacytoma of the gallbladder is particularly uncommon and has been described in only a handful of cases. Diagnosis of gallbladder plasmacytoma with fluorine 18-fluorodeoxyglucose (F18-FDG) positron emission tomography/computed tomography (PET/CT) has not previously been reported. We present a 65-year-old female with a history of multiple myeloma who underwent a restaging F18-FDG-PET/CT which showed a focal area of hypermetabolic activity, corresponding to a nodular lesion within the posterior gallbladder wall. The patient underwent successful cholecystectomy, with surgical pathology revealing gallbladder plasmacytoma. A follow-up scan was negative for active malignancy. This is a novel case of gallbladder plasmacytoma diagnosed on whole-body F18-FDG PET/CT - thus demonstrating the clinical value of this imaging modality in staging, restaging, and surveillance for patients with multiple myeloma.

Scintigraphic Diagnosis of Intrathoracic Splenic Implants Masquerading as Malignancy.

After significant trauma to the spleen, small viable splenic fragments may exist in the peritoneal cavity or, less commonly, in the thorax. Thus, the appearance of splenules within the thorax on CT images can easily be mistaken for malignancy and lead to unnecessary intervention. Here, we present a case of multiple pulmonary masses that initially were presumed to be malignancy, leading to CT-guided biopsy, but were eventually confirmed to be thoracic splenules through 99mTc-labeled sulfur colloid scintigraphy.

Gallbladder Fossa Abscess Masquerading as Cholecystitis After Cholecystectomy.

We present a case of a 59-y-old woman who had undergone cholecystectomy and was subsequently found to have an abscess within the gallbladder fossa. A hepatobiliary scan using (99m)Tc-diisopropyliminodiacetic acid demonstrated the characteristic rim sign, a photopenic defect surrounded by a rim of mildly increased activity immediately adjacent to the gallbladder fossa. The rim sign was thought to be the result of reactive inflammation in the hepatic tissue adjacent to a postoperative abscess within the gallbladder fossa.

Designing a constructed wetland for the detention of agricultural runoff for water quality improvement.

The goal of this study was to construct a wetland that would detain runoff from a 162-ha watershed for the purposes of improving water quality. The volume of runoff that needed to be detained was determined to be that amount coming off the 162-ha watershed consisting of 146 ha of cultivated crop land and 16 ha of pasture that exceeded the amount that would have come off of the watershed in its natural, forested state. The Soil Conservation Service (now the Natural Resource Conservation Service [NRCS]) runoff curve number method was used to estimate runoff from the watershed in its natural, forested state and in its current state of cultivated crop land and pasture. The design of the constructed wetland was accomplished using the natural topography of the wetland site and the design criteria for a sediment containment system developed by NRCS. The SPAW (Soil-Plant-Atmosphere-Water Field & Pond Hydrology) computer model was used to model depth and volume in the wetland to determine if the constructed wetland design would accommodate typical runoff events. Construction of the wetland occurred over a 4-mo period. The capabilities of the system were verified when Hurricane Rita deposited above-normal rainfall to the wetland site area. The wetland was able to accommodate this event, allowing flow through the system for 9 d, followed by continued detention of remaining runoff for water quality improvement.