Case Author(s): Lisa Oakley, M.D., Keith Fischer, M.D., Jerold Wallis, M.D. , 07/11/97 . Rating: #D2, #Q3
Diagnosis: Small bowel gastrointestinal bleed
Brief history:
53 year old with dizziness and maroon stools.
Images:
ANTERIOR IMAGES AT 5 MINUTE INTERVALS
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Full history/Diagnosis is available below
Diagnosis: Small bowel gastrointestinal bleed
Full history:
53 year old with dizziness and maroon stools, who presents with
hematocrit of 15 requiring transfusion. NG tube aspirate
is reportedly negative.
Radiopharmaceutical:
Tc99m tagged RBC
Findings:
Sequential images demonstrate tracer activity accumulation in a
small bowel pattern in the midline/left upper quadrant beginning at
5-10 minutes.
Discussion:
Accurate localization of the site of GI bleeding is crucial for
initiating effective therapy. A tagged RBC scan is well suited for
this task because of its great sensitivity and its ability to detect
hemorrhage even when it is intermittent. It is important to obtain
early sequential images to locate the exact site of hemmorhage because
blood travels quickly through bowel and can even relux proximally. In
fact, it is the movement of activity thru the abdomen (in the expected
course of bowel) that suggests the diagnosis of GI bleed. If persistent
gastric activity is seen with no movement through bowel, this may
indicate the presence of free Tc99m Pertechnetate which can be verified
by images of the neck showing uptake in the thyroid and salivary glands.
Followup:
Subsequent esophagoduodenoscopy showed a bleeding doudenal bulb ulcer.
Major teaching point(s):
This case is an example that nasogastric tube aspiration
of the stomach is not always a reliable indicator of an upper GI source
of bleeding.
ACR Codes and Keywords:
References and General Discussion of Gastrointestinal Bleeding Scintigraphy (Anatomic field:Gasterointestinal System, Category:Misc)
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Case number: gi005
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