Extra-cardiac multifocal lung uptake of 99m Tc-sestamibi in myocardial perfusion imaging: An asymptomatic case with coro
- PDF / 1,888,484 Bytes
- 4 Pages / 593.972 x 792 pts Page_size
- 115 Downloads / 148 Views
Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
Received Sep 16, 2020; accepted Sep 19, 2020 doi:10.1007/s12350-020-02393-w
BACK GROUND Incidental abnormal non-cardiac findings are not uncommon in single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI).1 Thorough inspection of rotating raw and reconstructed images may not only lead to discovery of important noncardiac disorder but also provide a hint of coronavirus disease 2019 (COVID-19) during its outbreak.2 We report a challenging finding of multifocal pulmonary uptake in an asymptomatic patient with typical features of pulmonary involvement with COVID-19 infection, incidentally noticed in SPECT MPI. CASE REPORT A 44-year-old man with past medical history of hypertension was referred to the department of nuclear medicine and molecular imaging of the Rajaie cardiovascular, medical and research center for preoperative risk stratification of renal surgery during COVID-19 epidemics. The patient’s symptom was only dyspnea on exertion (DOE) with no episode of chest pain and with normal sinus rhythm in pre-exercise phase electrocardiogram (Figure 1).The patient performed treadmill exercise stress test according to modified Bruce protocol. Fifteen mCi of 99mTc-sestamibi was injected at the peak of stress and exercise stress continued for another minute before completion of stress test as a result of fatigue. SPECT MPI study was performed with low-
Reprint requests: Nahid Yaghoobi, MD, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran; [email protected] J Nucl Cardiol 1071-3581/$34.00 Copyright Ó 2020 American Society of Nuclear Cardiology.
energy high-resolution collimators and a non-circular body contoured 180-degree acquisition arc from right anterior oblique to left posterior oblique, accompanied by CT acquisition (16 eff—mAs, 130 kV, 512 9 512 matrix size) for CT-based non-uniform attenuation correction, using a dual-head gamma camera (Symbia T6, Siemens Healthcare). All of the acquired and reconstructed images were visually quality controlled. The MPI was interpreted as stress-induced ischemia in the apical septal segment without regional wall motion abnormality with a left ventricular ejection fraction of 66% (Figure 2). Moreover, the reconstructed SPECT images demonstrated abnormal multifocal areas of extracardiac pulmonary uptake of 99mTc-sestamibi in both lungs, corresponding to the ground glass opacities in concurrent CT image, which was taken for nonuniform CT-based attenuation correction (Figures 3, 4). The chest radiograph in lying position and the reconstructed CT images with three-millimeter slice thickness demonstrated multiple peripherally distributed groundglass opacities in vicinity to the visceral pleural surfaces in both lungs, which were interpreted as typical feature for lung involvement of COVID 19 (Figures 5, 6).3 The patient was not tested immediately; however, he was instructed to be monitored and qu
Data Loading...
