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 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).


27.8 Tc-99m in vitro labeled red cells i.v.


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.


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.


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

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