False positive metastatic disease due to combined thoracic and subcutaneous splenosis.

A 56-year-old man presented with dyspnea secondary to pulmonary emboli and dilated cardiomyopathy. His past medical history included a history of emergency laparotomy, splenectomy, and splenic flexure resection following a gunshot injury 30 years ago. CT and MRI imaging demonstrated multiple homogeneously enhancing lobulated lesions at the left-sided pleura and chest wall with an irregular calcified spleen. The aforementioned lesions demonstrated a similar level of tracer uptake to the splenic activity with no evidence of other FDG avid malignancy on the follow-up 18F-FDG PET study. All the above-mentioned pleural and chest wall lesions demonstrated intense tracer accumulation on technetium-99m labeled heat-damaged red cell scintigraphy, consistent with combined thoracic and subcutaneous splenosis.

Peritoneal-scrotal dialysate leakage demonstrated on SPECT/CT imaging in a patient on peritoneal dialysis.

A 62-year-old male with end-stage renal failure on peritoneal dialysis presented with sudden onset scrotal swelling following a violent coughing fit. He was referred for a peritoneal leak study to evaluate the scrotal swelling. This case illustrates the benefit of SPECT/CT imaging in the diagnosis and anatomic localization of peritoneal leakage as a complication of peritoneal dialysis.

Dissecting Mycotic RCA Aneurysm Detected on 67Ga Scintigraphy.

ABSTRACT: A 61-year-old man presented with pneumonia and myocardial infarction on a background of diabetes and end-stage renal failure. Methicillin-resistant Staphylococcus aureus bacteremia was confirmed in the setting of ongoing pyrexia. The patient was referred for a 67Ga study, which revealed Ga-avid active disease in the pericardial effusion. This was localized further on CT/MRI and coronary angiography to a dissecting right coronary artery aneurysm, which was treated with surgical repair and long-term antibiotic treatment.

131I Ablation of an Entire Thyroid Gland in Locally Invasive Differentiated Thyroid Cancer Without Surgery.

ABSTRACT: A 79-year-old man with locally metastatic papillary thyroid cancer to left-sided cervical lymph nodes was referred for radioiodine therapy. He was considered unfit for thyroidectomy due to extensive local involvement and severe interstitial lung disease requiring continuous oxygen. The patient was treated with low doses of radioiodine (approximately 30 mCi) every 6 months with corticosteroid cover for 3 years with good effect. Sequential 131I scanning and serum thyroglobulin levels confirmed virtual complete ablation of the thyroid gland. The patient remained well on thyroid hormone replacement.

Pachymeningitis Demonstrated on Gallium SPECT/CT Scan.

A 34-year-old woman presented with a 3-month history of right-sided headaches associated with photophobia and pulsatile tinnitus. Investigations including lumbar puncture revealed elevated opening CSF pressure, increased protein, and presence of monocytosis consistent with an inflammatory/infective process. Brain MRI showed an area of thickened enhancing dura around the venous sinus posteriorly. Ga scintigraphy demonstrated focal intracranial uptake in the posterior occipital region, and biopsy confirmed a chronic inflammatory infiltrate with no granulomas.

Adrenocorticotropic Hormone-Secreting Neuroendocrine Tumor of the Rectum Demonstrated on 68Ga-DOTATATE and 18F-FDG PET Imaging.

An 81-year-old man with Cushing syndrome was referred for a Ga-DOTATATE PET/CT study to investigate for an ectopic source of adrenocorticotropic hormone. The scan demonstrated mildly increased octreopeptide uptake at a rectal mass and focal uptake at multiple regions throughout the bone marrow of the axial skeleton, consistent with metastases. A subsequent F-FDG PET/CT study was performed for further evaluation and demonstrated markedly increased metabolism at the previously identified rectal mass, in addition to the liver and multiple regions throughout the skeleton. Histopathology from biopsy of the rectal mass confirmed a small cell neuroendocrine carcinoma.

Incidental 99mTc-HDP Uptake in a Dominant Thyroid Nodule on Bone Scan.

A 67-year-old woman was referred for a bone scan for evaluation of increasing serum alkaline phosphatase levels. Bone scan revealed no abnormal uptake in the skeleton. However, intense hypervascularity and delayed tracer uptake were incidentally identified in an enlarged right thyroid gland. A thyroid scintigraphy, contrast-enhanced CT of the neck, and sonographic evaluation of the abnormality were subsequently organized to characterize the lesion. An ultrasound-guided fine-needle aspiration revealed a benign follicular pattern (Bethesda II), and histopathology of the right hemithyroidectomy confirmed a dominant nodule within a nodular goiter.