Case Author(s): Samuel Wang, M.D. and Keith Fischer, M.D. , 5/18/97 . Rating: #D3, #Q3
Diagnosis: Metastatic pheochromocytoma.
Brief history:
61 year old woman with
lung nodules and complaints of palpitations,
headaches, and hypertension.
Images:
Delayed 48 hour anterior and posterior whole body images.
View main image(mb) in a separate image viewer
View second image(ct).
CT of the chest.
Full history/Diagnosis is available below
Diagnosis: Metastatic pheochromocytoma.
Full history:
61 year old woman with
history of left adrenal gland
pheochromocytoma resected 10 years ago.
Beginning approximately one year ago, the
patient has experienced recurrent symptoms
including palpitations, headaches, and
transient hypertension. A recent CT
demonstrated multiple pulmonary nodules.
Radiopharmaceutical:
0.54 mCi I-131
metaiodobenzylguanidine i.v.
Findings:
Multiple foci of abnormal I-
131 MIBG accumulation are seen medially in
the right lung base corresponding to
pulmonary nodules seen on CT. There are also
multiple other foci seen in the left lung base,
the liver and the right humerus. Given the
patient's history, these findings are most
consistent with metastatic pheochromocytoma.
There is expected activity in the salivary
glands, myocardium, liver, GI tract, and
bladder.
Discussion:
I-131 MIBG is an analog of
norepinephrine and is taken up selectively by
the adrenal medulla, the sympathetic
autonomic nervous system, and tumors
derived from these tissues. It is currently
primarily used in the diagnosis and staging of
pheochromocytoma and neuroblastoma.
Many drugs interfere with uptake of MIBG,
particularly tricyclic antidepressants,
sympathomimetics, and certain
antihypertensives. Radiation dose to the
thyroid gland should be minimized by
blocking of thyroidal I-131 uptake with
potassium iodide or Lugol's solution.
ACR Codes and Keywords:
- General ACR code: 83
- Genitourinary System:
8.328 "Pheochromocytoma include: benign pheochromocytoma, multiple endocrine neoplasis type II"
References and General Discussion of MIBG Scintigraphy (Anatomic field:Genitourinary System, Category:Neoplasm, Neoplastic-like condition)
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Case number: mb004
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