ABSTRACT
Ectopic thyroid tissue is very rare, but the coexistence of ectopic and eutopic thyroid glands is even more rare. The recognition of this diagnosis is important in patients who are being treated for thyrotoxicosis, but it is also crucial to exclude other associated serious disease conditions. In this article, we report three different cases that showed ectopic thyroid tissue with the coexisting presence of an eutopic thyroid gland. All three cases showed different outcomes. The recognition of this condition is of great importance because it alerts the referring physicians to this rare, yet possible occurrence and the potential pathological conditions associated with it. The first case showed how imaging could help outline even small ectopic thyroid tissue outside of the neck region even in cases where histopathological confirmation is difficult. The second case was very rare as thyroid carcinoma originated in ectopic thyroid tissue. In the last case, the initial imaging was misleading as it mimicked greatly ectopic thyroid tissue, and only detailed history and careful inspection of the images could lead to the correct interpretation of the findings.
ABSTRACT
Q fever is an epidemic disease caused by the Coxiella burnetii infection. It can manifest clinically as an acute or chronic disease, with chronic infections being more common. Q fever endocarditis is the most common manifestation of chronic infection and usually occurs in patients with previous valvular heart disease like in our present study, a case of Q fever endocarditis that occurred in background of tetralogy of Fallot surgical repair. However, Q fever endocarditis is difficult to diagnose clinically and may lead to very serious or even life-threatening outcomes if not diagnosed promptly. In the present study, accurate diagnosis and treatment were achieved by 18F-FDG PET/CT combined with detection of the Q fever serological antibodies.
ABSTRACT
The aim of this observational cross-sectional study with retrospective review of the data is to evaluate the efficacy of using technetium-99m-octreotide (Tc-99m-OCT) in imaging neuroendocrine tumors (NETs) in our tertiary care hospital. A total of 58 patients had Tc-99m-OCT were identified in our database, from January 2013 to December 2016. Forty-one patients (age range of 15-75 years) meet our inclusion criteria, namely histopathology proven NETs, Tc-99m-OCT scan, computed tomography (CT), or magnetic resonance imaging (MRI) done in our institute for correlation. Twenty-three patients had true positive Tc-99m-OCT scan. In addition to the primary tumors, the octreotide scan revealed metastasis in the lung, liver, and retroperitoneal lymph nodes. The smallest lesion detected on octreotide scan was a 4-mm pulmonary nodule that was missed on lung window CT scan. The Tc-99m-OCT had 17 true negative, one false negative, and no false positive. The CT and MRI scans had 18 true positive, 17 true negative, 5 false negative, and one false positive. The overall sensitivity, specificity, accuracy, positive, and negative predictive values of Tc-99m-OCT scan were 96%, 100%, 97%, 100%, and 94%, respectively. Whereas those of CT and MRI were 78%, 94%, 85%, 94%, and 77%, respectively. Our diagnostic accuracy of Tc-99m-OCT is high. We recommend that, in addition to the conventional radiological investigations, Tc-99m-OCT scan, or other somatostatin receptor imaging (SSR) is a mandate for better and accurate staging of patients with NETs.
ABSTRACT
OBJECTIVES: Although (18)F-fluorodeoxyglucose positron emission tomography (PET)/computed tomography (CT) has largely replaced the use of gallium-67 ((67)Ga) scintigraphy in the evaluation and follow-up of lymphoma patients, (67)Ga scans are still of value, particularly in countries where no PET/CT service is available. The current study presents the experience of a tertiary care centre using (67)Ga scintigraphy for the evaluation of lymphomas and infections. METHODS: A retrospective review was conducted of all (67)Ga scans performed between 2007 and 2011 at the Royal Hospital in Muscat, Oman. Images and reports of (67)Ga scans were compared to clinical and radiological follow-up data including CT and PET/CT scans and biopsies when available. RESULTS: A total of 74 patients were referred for (67)Ga scintigraphy during this period with 12 patients excluded due to lack of follow-up data, resulting in 62 patients. Among these patients, 90 (67)Ga scans were performed, including 59 for lymphoma, 29 for infection and two for sarcoidosis assessment. Of the infection assessment scans, 22 were performed to assess pyrexia of unknown origin and seven for follow-up after known infections. Sensitivity and specificity were found to be 80% and 88%, respectively, for the lymphoma assessment scans. For the infection assessment scans, sensitivity and specificity were reported to be 80% and 100%, respectively. CONCLUSION: Results from this study were consistent with other reported rates of (67)Ga scan sensitivity and specificity in the evaluation of lymphomas and infections. This indicates that (67)Ga scintigraphy is a useful tool for these types of evaluations when PET/CT services are not available.
ABSTRACT
Carcinoid tumors are relatively rare and can occur in the thorax, abdomen, or pelvis. Functional imaging in the form of Indium-111 pentetreotide scanning is widely used for identification of these tumors and it exploits the fact that the vast majority of these tumors express somatostatin receptors on their cell membrane. In this report, we present a case of a 76-year-old man who was diagnosed with peritoneal carcinomatosis. The findings of the initial imaging made by planar and single photon emission computed tomography were misleading and the actual diagnosis was only made by single photon emission computed tomography/computed tomography.
ABSTRACT
Iatrogenic chyle leak with chyloma formation in the neck is a rare complication of neck dissection resulting from injury to the thoracic duct. We present the case of a 37-year-old woman who complained of left-sided neck swelling within days after total thyroidectomy and lateral neck dissection for papillary thyroid cancer. Lymphoscintigraphy demonstrated the chyle leak in the left cervical region, and subsequent aspiration of the left neck swelling showed radioactivity in the aspirate. After successful operative repair of the thoracic duct, the patient was able to undergo radioactive ablative thyroid treatment.