Significance of MIBI scintigraphy in a patient with hydatid cyst and parathyroid adenoma

A 17-year-old boy with hyperparathyroidism exhibited a large cyst in the left hemi-thorax on his chest X-ray. The cyst was identified as a hydatid cyst. He was referred for biphasic methoxy isobutyl isonitrile [MIBI] parathyroid scan. A discrete ectopic parathyroid was detected in the left upper mediastinum in addition to accumulation of the MIBI tracer in the cyst wall. Using radio-guided occult lesion localization with an injection of 3 mCi 99m Tc - MIBI in the morning of the operation day, an ectopic adenoma was detected with a gamma probe within the thymus, resected with a consequent decline of serum high parathyroid hormone [PTH]. This report is remarkable in two different aspects: the importance of radio-guided localization of ectopic adenoma, which in this case was within the thymus, and the accumulation of MIBI in hydatid cyst wall, as a unique report of this condition

incidental lung lesion: effect of cardiac stress on the MIBI uptake in the lung mass

A discrete MIBI avid lung lesion was found in cinematic views of myocardial perfusion imaging [MPI] of a 59 year-old woman. Interestingly, the abnormal uptake in the lung was detectable only in the rest phase images and not in the images acquired in the stress phase. MPI was performed for pre-operation cardiac risk assessment before correction surgery for spinal canal stenosis. She had no past medical history or symptoms concerning pulmonary problems. The clinical examination of the pulmonary system was normal. MPI was reported normal but for the lung lesion she was sent for consultation with pulmonologist. The pulmonologist diagnosed the lesion was an old inflammatory/infective lesion probably secondary to tuberculosis. No histopathological examination was done. By reporting this case we intended to highlight the possibility of the effect of stress on uptake of MIBI in tumoral lesions as a tumor agent in nuclear medicine