Case Author(s): David Hillier, M.D., Ph.D. and Jerold Wallis, M.D. , . Rating: #D3, #Q4

Diagnosis: Breast carcinoma

Brief history:

75 year-old woman with breast carcinoma.

Images:

Radionuclide ventriculogram. (Particularly note the 35 LAO view)

View main image(ca) in a separate image viewer

View second image(ca). Radionuclide ventriculogram and computed tomography

Full history/Diagnosis is available below


Diagnosis: Breast carcinoma

Full history:

75 year-old woman with breast carcinoma undergoing evaluation of left ventricular function.

Findings:

1. Radionuclide ventriculogram:

- Confusing appearance of left ventricle. Appears to have filling defect.

- Additional view (25 LAO) reveals a rim of activity correlating with the large known left breast carcinoma.

2. Computed tomography of the chest:

- Large left breast mass.

Discussion:

A large defect that is only seen on a single view should raise the suspicion of an artifact. If a defect is seen on multiple views, but in the same location with respect to the camera, a photomultiplier tube malfunction, collimator damage, attenuator attached to the camera face or other source of artifact that is associated with the camera should be suspected.

References:

Caluser C, et al. The relationship between thallium uptake, blood flow, and blood pool activity in bone and soft tissue tumors. Clin Nucl Med. 17, 565-572. 1992.

Meyer GJ, et al. Quantification of regional extravascular lung water in dogs with positron emission tomography, using constant infusion of O-15-labeled water. Eur J Nucl Med. 9, 220-228. 1984.

Differential Diagnosis List

In the initial set of cardiac blood pool images, there is an apparent large defect centered over the left ventricle on the best-septal view. The differential diagnosis would include causes of filling defects, such as thrombus. However, the defect is not seen on the other two views. This should raise the suspicion of an artifact. In this case, the patient has breast cancer. The large left breast mass created an attenuation artifact centered over the left ventricle, with superimposed increased activity at the margins of the tumor, and decreased activity in the center (likely due to central necrosis). In a repeat, slightly obliqued view (25 vs 35), a defect with an increased rim of activity and cold center becomes apparent outside of the left ventricle. Computed tomography reveals the large left breast mass.

ACR Codes and Keywords:

References and General Discussion of Cardiac Blood Pool Scintigraphy (Anatomic field:Heart and Great Vessels, Category:Neoplasm, Neoplastic-like condition)

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Case number: ca004

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