Enterogastroesophageal reflux detected on 99m-technetium sestamibi cardiac imaging as a cause of chest pain

Abstract

Myocardial perfusion imaging (MPI) with technetium-99m sestamibi (Tc-99m MIBI) is considered a diagnostic technique that is widely used for the investigation of suspected coronary artery disease. Incidental inspection of an extracardiac activity is indirect, but important marker, which can identify a potentially treatable non-coronary cause for chest pain that may mimic cardiac symptoms. Here, we present an illustrative case in which significant enterogastroesophageal reflux of Tc-99m MIBI occurred during the cardiac imaging following prompt hepatobiliary clearance. Because, there was normal myocardial perfusion on MPI, presence of gastroesophageal reflux (GER) on GER scintigraphy and detection of mild inflammation with pathologically confirmed hyperplastic polyp by endoscopy, in view of the above findings we concluded that the probable cause of chest pain was reflux.

Incidental Findings on Myocardial Perfusion SPECT Images

“…7-9). This finding exemplifies a common hurdle in the interpre-tation of myocardial perfusion images-the presence of increased activity in the liver, bowel, or stomach, predominantly affecting the inferior wall-as all 99m Tc-labeled myocardial perfusion agents are cleared by the liver and excreted by the biliary system into the duodenum (9). Various techniques have been used to reduce this uptake, with varying degrees of success (10).…”

Congenital superior sternal cleft repair using our modified Sally technique: A case report

“…10 When bile reflux presents several typical symptoms associated to chest pain, as heartburn, flatulence and/or nausea, is easily identifiable. Of them, up to 50% have pain secondary to digestive disorders.…”

Émergence de cellules souches cancéreuses ou cellules initiatrices/propagatrices de tumeurs et phénomène de rechute dans le myélome multiple

“…Of them, up to 50% have pain secondary to digestive disorders. 10 When bile reflux presents several typical symptoms associated to chest pain, as heartburn, flatulence and/or nausea, is easily identifiable. However, when it only manifests as chest pain is difficult to establish its etiology, being necessary to rule out coronary disease.…”