Scintigraphic detection of hemobilia complicating angiodysplasia.

A 78-yr-old man underwent 99mTc-labeled red cell examination for a gastrointestinal bleeding episode. Gallbladder visualization was noted during the examination. Hemobilia has been reported in a variety of pathologic conditions; scintigraphic gallbladder visualization has also been reported as a result of the unusual radiolabeling characteristics of 99mTc during red cell scintigraphy. Postmortem examination revealed angiodysplasia of the gallbladder and other sites in the gastrointestinal tract. Angiodysplasia must be considered in the pathologic spectrum of causes of hemobilia.

Superior vena cava obstruction in fibrosing mediastinitis: demonstration of right-to-left shunt and venous collaterals.

Multiple venous collateral pathways have been described in patients with superior vena cava obstruction. Systemic venous-to-pulmonary venous communication is the most unusual, having been described in a few cases of thoracic malignancy. In a patient with fibrosing mediastinitis radionuclide venography with 99Tcm-macroaggregated albumin demonstrated a systemic venous-pulmonary venous right-to-left shunt in addition to systemic and portal venous collaterals. It is apparent that systemic venous-to-pulmonary venous anastomoses may occur in the absence of malignant disease.

Morphine-augmented cholescintigraphy in acute cholecystitis. A satisfactory alternative to delayed imaging.

The utility of morphine-augmented cholescintigraphy was reviewed in 32 patients with suspected acute cholecystitis. All patients were administered 2 mg morphine sulfate intravenously when the gallbladder failed to visualize 30 minutes into the study, and imaging continued for up to 60 minutes. Sensitivity for detection of acute cholecystitis was 93% (13 out of 14). Specificity was 78% (14 out of 18). Three of four false-positives occurred in the setting of prolonged fasting and chronic cholecystitis. Cumulative experience suggests that the technique is diagnostically equivalent to imaging for up to 4 hours and that specificity remains incomplete in the setting of prolonged fasting, chronic cholecystitis and other conditions known to affect conventional cholescintigraphy.

Axillary iodine-131 accumulation due to perspiration.

A case of spurious axillary uptake of I-131 proven to be caused by perspiration is presented. False-positive localizations of radioiodine, both pathologic and physiologic, are reviewed to avoid confusion of these entities with functioning thyroid carcinoma metastases.