Pulmonary sequestration: a 131 I whole body scintigraphy false-positive result
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CASE REPORT
Pulmonary sequestration: a false-positive result Elena Giulia Spinapolice • S. Chytiris C. Fuccio • P. Leporati • G. Volpato • L. Villani • G. Trifiro` • L. Chiovato
131
I whole body scintigraphy
•
Received: 1 October 2013 / Accepted: 7 March 2014 Ó The Japanese Society of Nuclear Medicine 2014
Abstract A 35-year-old woman affected by a well-differentiated papillary thyroid carcinoma was referred to our hospital to perform a 131Iodine (131I) whole body scintigraphy for restaging purpose. The patient had been previously treated with total thyroidectomy and three subsequent doses of 131I for the ablation of a remnant jugular tissue and a suspected metastatic focus at the superior left hemi-thorax. In spite of the previous treatments with 131I, planar and tomographic images showed the persistence of an area of increased uptake at the superior left hemi-thorax. This finding prompted the surgical resection of the lesion. Histological examination of the surgical specimen showed the presence of a pulmonary tissue consistent with pulmonary sequestration. Even though rare, pulmonary sequestration should be included in the potential causes of false-positive results of radioiodine scans.
E. G. Spinapolice (&) C. Fuccio G. Trifiro` Nuclear Medicine Unit, Fondazione Salvatore Maugeri, 27100 Pavia, Italy e-mail: [email protected] S. Chytiris P. Leporati L. Chiovato Internal Medicine and Endocrinology Unit, Fondazione Salvatore Maugeri, Pavia, Italy G. Volpato Thoracic Surgery, University of Pavia, Pavia, Italy L. Villani Pathology and Cytology Unit, Fondazione Salvatore Maugeri, Pavia, Italy
Keywords 131I whole body scintigraphy Thyroid carcinoma Pulmonary sequestration Pulmonary disease
Introduction Pulmonary sequestration (PS) is a congenital bronchopulmonary malformation due to dysplastic lung tissue, which lacks communication with the trachea-bronchial tree and receives blood supply from systemic arteries. PS is classified into two forms, depending on whether the abnormal lung tissue is enveloped by its own pleural covering: intra-lobar or extra-lobar sequestration, respectively [1]. In patients presenting with non-specific complaints or no symptoms at all, PS may be discovered as an incidental pulmonary lesion on imaging. More commonly, PS is associated with variable degrees of pulmonary signs and symptoms, such as pleural effusion or recurrent pneumonia [2]. Occasionally, PS may even be misdiagnosed as a pulmonary disease, including abscess or tumor [3]. Surgical resection of the affected lung segment is the traditional treatment of PS. In case of pulmonary infection with the destruction of normal tissue, major resections may be considered, such as lobectomy or pneumonectomy [1]. We hereby describe the case of a young woman who had been treated with total thyroidectomy and 131Iodine (131I) for papillary thyroid cancer. Both the post therapy and the diagnostic 131I whole body scans gave a false-positive result due to pulmonary sequestration. To the best of our knowledge, altho
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