Case Author(s): Charles Pringle, M.D./ Keith Fisher, M.D. , August 6, 1995 . Rating: #D3, #Q.
Diagnosis: Free Technetium
Brief history:
Melena, rule out lower
gastrointestinal bleed
Images:
Images through two hours
View main image(gi) in a separate image viewer
View second image(mm).
Imaging over patient's neck
Full history/Diagnosis is available below
Diagnosis: Free Technetium
Full history:
58-year old woman with past
history of aortic valve replacement, now on warfarin.
She presents with melena and anemia (hematocrit of
15.7).
Radiopharmaceutical:
27.8 Tc-99m in vitro
labeled red cells i.v.
Findings:
Immediate images demonstrate
activity within the gastric fundus and, over two hours,
this activity progresses from the stomach into the
small bowel. No focal areas of increased activity
within the bowel were suggestive of lower
gastrointestinal bleed. Static imaging over the
patientıs head and neck revealed a large amount of
activity in the region of the mouth, although no
significant activity was identified in the region of the
thyroid gland or greater salivary glands.
Discussion:
It is unusual for free technetium
to only localize to the oral mucosa (lesser salivary
glands). Normally, free technetium is identified
within the thyroid gland and major salivary glands. A
possible explanation would be that this patient had
received iodinated contrast recently. However, no
such history could be elicited.
Followup:
Patient subsequently received an
upper endoscopy which was normal to the proximal
jejunum. A prior colonoscopy and upper GI with small
bowel follow-through (approximately one month
earlier) had both been normal. The source of the
patientıs gastrointestinal bleed is presumed to be
small bowel A.V.M.ıs.
Differential Diagnosis List
Massive
gastric bleeding. This is much less likely since the
patient had no history of vomiting of blood.
ACR Codes and Keywords:
References and General Discussion of Gastrointestinal Bleeding Scintigraphy (Anatomic field:Gasterointestinal System, Category:Normal, Technique, Congenital Anomaly)
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Case number: gi002
Copyright by Wash U MO
