LEARN NUCLEAR MEDICINE
Read the history, inspect the study, then reveal the teaching.
IMAGE PLACEHOLDER · Diagnostic study
Original study · Companion image placeholders
67-year-old female presents to the ED with chest pain. A nuclear stress test was performed for further evaluation.
Read the images before opening the teaching panel below.
Resting images demonstrate very poor quality images (particularly short axis). Stress images demonstrate normal myocardial perfusion; however, careful attention to the stress images demonstrates that the left and right ventricle ares swapped in expected location.
Initially one could think the poor quality of the resting images could be secondary to patient motion; however, when you recognize the abnormal position of the left ventricle to the right ventricle the diagnosis of dextrocardia is clear. This was confirmed by the provided x-ray.
It was learned in between the rest and stress acquisition of the two parts of the study that the patient had dextrocardia therefore stress images were acquired with the camera rotating over the right side of the thorax resulting in improved image quality as the camera did not have to image through the left lung to obtain counts from the myocardium.
Lee F, Maggiore P, Chung K. Self-Management of an Inferior ST-Segment Elevation Myocardial Infarction. New England Journal of Medicine. 2018;378(10):960-962. doi:10.1056/nejmc1716701.
https://www.researchgate.net/figure/Tl-myocardial-SPECT-reversible-defect-in-the-anterior-wall-left-ventricular-cavity_fig1_8667419
https://docs.google.com/presentation/d/17voHWaH6_tef7RNMQ5U59ZhWrgx2ttki/edit#slide=id.p31