Case Author(s): V. Klaas , 12\16\94 . Rating: #D., #Q5
Diagnosis: MAA injection while on ECMO
Brief history:
39 year old female who underwent bilateral lung
transplantation and repair of a VSD three days ago.
She is now referred for evaluation of pulmonary perfusion
(split function).
Images:
Anterior view of chest, after MAA injection (ECMO turned on)
View main image(pe) in a separate image viewer
View second image(pe).
anterior view of chest. TC 99m MAA injected after
ECMO was turned off.
Full history/Diagnosis is available below
Diagnosis: MAA injection while on ECMO
Full history:
39-year old woman who previously underwent
bilateral pulmonary transplantation and repair of a
ventriculoseptal defect. The patient is currently on
extracorporeal membrane oxygenation (ECMO) and is referred
for evaluation of pulmonary perfusion.
Findings:
The initial image demonstrates uptake in the
myocardium. The reason for this is that the patient was
on ECMO during the injection of Tc-99m MAA.
During ECMO blood is removed from the right atrium
and sent through the ECMO chamber for oxygenation
and then returned to the aortic root. Because of this, the
Tc-99m MAA was also shunted directly from the right
atrium to the aortic root with subsequent deposition in
the myocardium. This problem was immediately
recognized. Subsequently, the ECMO was turned off
momentarily while a second dose of Tc-99m MAA was
administered intravenously with resultant deposition in
the pulmonary vascular bed as had been initially
desired. Evaluation of pulmonary perfusion
demonstrated asymmetry with the right lung receiving
94% and the left lung 6% of the total pulmonary
perfusion.
Followup:
The patient is currently under the care of the
critical care team. Plans have been made for in-service
training regarding ECMO for the nuclear medicine
technical staff.
Major teaching point(s):
It is important when evaluating any patient who is on ECMO
to understand the basics about ECMO and how it may effect
the uptake of any radiopharmaceutical. In this case, the injection
which was made while ECMO was operating resulted in significant uptake in the myocardium, with essentially no uptake in the pulmonary vascular bed. The injection made after ECMO was turned off resulted in deposition in the pulmonary bed, as was desired.
ACR Codes and Keywords:
References and General Discussion of Perfusion (only) Scintigraphy (Anatomic field:Lung, Mediastinum, and Pleura, Category:Normal, Technique, Congenital Anomaly)
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Case number: pe002
Copyright by Wash U MO
