Case Author(s): Thomas H. Vreeland,MD /J. Wallis, M.D. , 04/10/94 . Rating: #D2, #Q3

Diagnosis: Prominent (normal) atrial activity

Brief history:

Rule out ischemia prior to ECT therapy.


Dipyridamole-Thallium: (Rows) Top = Stress; Bottom = Rest

(Columns) 1=septal; 2=anterior; 3=70 degree LAO

View main image(mi) in a separate image viewer

Full history/Diagnosis is available below

Diagnosis: Prominent (normal) atrial activity

Full history:

This patient is an 83 year-old woman with a history of atrial fibrillation, congestive heart failure, and hypertension, who is being evaluated to rule out ischemia prior to receiving ECT treatment for refractory depression.


Myocardial Imaging (Dipyridamole/Redistribution-planar only):

1. Normal variant with prominent activity seen in all four chambers.

2. No evidence of ischemia.


Comparison with a chest radiograph confirmed the unusual uptake to be in the expect region of the artria, which can be seen as a normal variant. Increased atrial uptake may relate to hypertrophy. The patient has no history of malignacy, making uptake by mediastinal tumor unlikely.

Major teaching point(s):

Differential Diagnosis List

Differential for Soft tissue uptake of Thallium in the mediastinum is modified from Datz, Frederick L. : Gamuts in Nuclear Medicine, 2nd Edition.(See References):

1. Normal Variant

2. Tumors (benign or malignant)

3. Substernal Thyroid - rare

4. Atrial hypertrophy

ACR Codes and Keywords:

References and General Discussion of Myocardial Imaging (Anatomic field:Heart and Great Vessels, Category:Normal, Technique, Congenital Anomaly)

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Case number: mi001

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