Peritoneoscintigraphy using Tc-99m MAA for diagnosis of diaphragmatic disruptions in trauma patients.

The diagnosis of diaphragmatic disruptions secondary to blunt trauma is difficult because the patients are usually asymptomatic. Delay in recognition of this injury can be life threatening. The presence of previous pulmonary pathology makes the diagnosis even more difficult to establish. In this report, a diaphragmatic tear was diagnosed using intraperitoneal instillation of Tc-99m MAA.

Spinal-cerebrospinal fluid leak demonstrated by radiopharmaceutical cisternography.

Cerebrospinal fluid (CSF) leaks are known to occur under several conditions: lumbar puncture performed for contrast myelography, spinal surgery, spinal stab wounds, fracture of the thoracic spine, inadvertent spinal puncture during epidural anesthesia, traumatic lumbar meningocele, and bronchopleural subarachnoid fistula due to bronchogenic carcinoma. Spontaneous spinal leaks are uncommonly encountered in neurosurgical practice, but they are increasingly recognized as a cause of spontaneous intracranial hypotension. Most CSF leaks are located at the cervicothoracic junction or in the thoracic spine. The disease is often self-limiting. A CSF leak can be detected directly by accumulation of radioactivity outside the subarachnoid space or suggested indirectly by the rapid disappearance of tracer from the subarachnoid space and early appearance in the urinary bladder. In this paper we present two unusual cases of CSF leak identified by radiopharmaceutical cisternogram.