Go with the flow: Abnormal extra-cardiac Rb-82 flow as a diagnostic clue for subclavian vein stenosis
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Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX
Received Nov 2, 2020; accepted Nov 3, 2020 doi:10.1007/s12350-020-02442-4
CASE Introduction Abnormal extra-cardiac uptake of Rb-82 may occur for varied reasons but the spectrum and significance of this are not well studied.1-3 We report a case of Rb-82 pooling in the right subclavian vein suggestive of subclavian vein stenosis. Case Summary A 56-year-old male with a history of coronary artery bypass grafting and end-stage renal disease on hemodialysis was referred for Rb-82 stress PET perfusion imaging. A standard rest-stress protocol was carried
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12350-020-02442-4) contains supplementary material, which is available to authorized users. Reprint requests: Mouaz H. Al-Mallah, MD, MSc, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, 6550 Fannin St, Sm 1801, Houston, TX 77030; [email protected] J Nucl Cardiol 1071-3581/$34.00 Copyright Ó 2020 American Society of Nuclear Cardiology.
out with injection of 10 mCi of Rb-82 using constantflow-rate (bolus) administration over 30 seconds followed by saline flush of 30cc. This was followed by image acquisition for seven minutes. Pharmacologic stress with Regadenoson was performed followed by an injection of 10 mCi of Rb-82 and a seven-minute image acquisition. Perfusion images revealed a fixed defect suggestive of scar in the apical inferior wall (Image 1). The time activity curves of the dynamic images revealed a double peak in the input function despite the constant flow (Image 2). Review of the extra-cardiac fields showed abnormal pooling of Rb-82 in the right subclavian vein associated with slow flow due to known right subclavian vein stenosis from prior dialysis catheters (Image 3, Video 1).
Thakkar et al Go with the flow
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Journal of Nuclear CardiologyÒ
Journal of Nuclear CardiologyÒ
Thakkar et al Go with the flow
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DISCUSSION This case demonstrates a previously unreported cause of extra-cardiac pooling of Rb-82 due to subclavian vein stenosis. An important consideration in this case is whether the presence of venous stenosis on the injection side could slow the rate of cardiac uptake of Rb-82. This will impact accurate assessment of myocardial blood flow. This needs to be considered in dialysis dependent patients who may have had multiple central venous catheters and thus are more prone to vein stenosis. In patients with known stenosis, an alternate site of injection is preferred.
References 1. Mirpour S, Khandani A. Extracardiac abnormalities on rubidium-82 cardiac positron emission tomography/computed tomography. Nucl Med Commun. 2011;32:260-4. 2. Al-Mallah MH, Sitek A, Moore SC, Di Carli M, Dorbala S. Assessment of myocardial perfusion and function with PET and PET/CT. J Nucl Cardiol. 2010;17(3):498-513. 3. Al Badarin F, Aljizeeri A, Almasoudi F, Al-Mallah MH. Assessment of myocardial blood flow and coronary flow reserve with po
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