LEARN NUCLEAR MEDICINE
Cardiology · Case 10
Read the history, inspect the study, then reveal the teaching.
IMAGE PLACEHOLDER · Diagnostic study
Original study · Companion image placeholders
Clinical history
A 60 year old woman presents with atypical left sided chest pain. She has no known history of coronary artery disease. She has risk factors of dyslipidemia, smoking, diabetes. A stress MPI shows no perfusion. However in cine mode, the raw data shows focal right breast uptake. The SPECT images were reprocessed and demonstrate focal uptake corresponding to an asymmetric right breast mass. This is concerning for primary breast cancer and further evaluation with mammogram, breast ultrasound and biopsy is recommended.
Previous
Next
Read the images before opening the teaching panel below.
Lung Carcinoma and mediastinal lymphadenopathy found on SPECT
Imaging Findings
Small area of decreased perfusion along the inferior wall which may represent a small area of ischemia or differential diaphragm. Hopefully you noticed the increased uptake within the mediastinum on cine images. CT images provided below
Essential Facts
Sestamibi is a non-specific tumor marker
Review rotating cines for extra-cardiac activity
Lung cancer is #1 death in men and women
Lung cancer commonly spreads to mediastinal and hilar lymph nodes so pay attention to these nodes on cine
References
https://docs.google.com/presentation/d/1S25rPg9YYMF3r-DoaSxZxEhEujCEbVZx/edit#slide=id.p22 “Nuclear Cardiology lecture” (no references)
Muzaffar1, Razi, et al. “Razi Muzaffar.” Journal of Nuclear Medicine Technology, 1 Sept. 2017, tech.snmjournals.org/content/45/3/175.full.