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.


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.


0.54 mCi I-131 metaiodobenzylguanidine i.v.


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.


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:

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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