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52-YEAR-OLD MAN WITH SHORTNESS OF BREATH, NAUSEA AND CHEST PAIN
Authored By: Asif Moinuddin and Barry Siegel, Prof of Radiology.
Patient: 52 year old male
History: 52-year-old man with chest pain, dyspnea, and nausea. He had a myocardial infarction in March 2007. He is status post stent placement. Evaluate for myocardial ischemia
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Multimedia: 96418_1_submitted.avi

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Findings: RADIOPHARMACEUTICAL: 2.7 mCi Tl-201 chloride i.v. and 21.5 mCi Tc-99m sestamibi i.v.
FINDINGS:
Normal myocardial perfusion. However, there is a focus of increased activity that is present near the right hilum, seen on the projection images as well as the SPECT images. A recent chest radiograph showed no definite correlate. Further evaluation with CT examination was recommended.
DDx: Tracer uptake in an anterior mediastinal mass.  Thymoma or lymphoma are most likely.
Diagnosis: CT demonstrated a 4 cm enhancing anterior mediastinal mass just to the right of midline and deep to the right internal mammary artery. There are small regions of low-attenuation centrally within the mass, which may reflect necrosis. This lesion is most consistent with a thymoma. An alternative and less likely diagnosis is lymphoma.

To date, no pathologic confirmation has been obtained.
General Discussion:

 




Specific Discussion:

Extracardiac focal uptake is best visualized by evaluating cine images.Uptake of both Tl-201 and Tc-99m sestamibi in both benign and malignant thymomas has been previously described. A single focus of radiotracer uptake on Tl-201 images with no matching lesion on the Tc-99m study is suggestive of poorly-differentiated thymoma. In contrast, focal uptake on the Tc-99m study and no correlating lesion on the Tl-201 study is more consistent with a well-differentiated tumor and, hence, a more favorable outcome.
References:

Tc-99m MIBI and TI-201 uptake in a benign thymoma.

Adalet I, Kocak M, Ece T, Yilmazbayhan D, Cantez S.

Clin Nucl Med. 1995 Aug;20(8):733-4.

Uptake of 99mTc-tetrofosmin, 99mTc-MIBI and 201Tl in malignant thymoma.

Hashimoto T, Goto K, Hishinuma Y, Yachuda K, Sugioka Y, Arai K, Harada S, Goto M.

Ann Nucl Med. 2000 Aug;14(4):293-8.

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Additional Details:

Case Number: 96418Owner(s): Asif Moinuddin and Barry Siegel, Prof of RadiologyLast Updated: 02-07-2013
Anatomy: Other   Pathology: Neoplasm
Modality: Nuc MedAccess Level: Readable by all users, writable by NucMed Certifiers
Keywords: minm, mediastinal mass, tumor, lymphoma, thymomaACR: 60000.39100

Case has been viewed 39 times.
Certified by Akash Sharma on 06-25-2009

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