Huge Varicose Inferior Mesenteric Vein: an Unanticipated 99m Tc-labeled Red Blood Cell Scintigraphy Finding

Hoseinzadeh, Samaneh; Shafiei, Babak; Salehian, Mohamadtaghi; Asli, Isa Neshandar; Ghodoosi, Iraj

doi:10.1007/s13139-010-0033-0

Cited by 5 publications

(2 citation statements)

References 21 publications

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“…Although not included in our clinical series, many other vascular abnormalities other than aortic aneurysm may be incidentally detected on GIB scintigraphy studies, such as hemangiomas, great vessel tortuosity, varices, arteriovenous malformations, and aortaenteric fistulas ( 24 , 25 , 26 , 27 ). Clinicians should be aware that these vascular anomalies may cause false-positive results for GIB.…”

Section: Discussionmentioning

confidence: 99%

The Diagnostic Contribution of SPECT/CT Imaging in the Assessment of Gastrointestinal Bleeding: Especially for Previously Operated Patients

Demir

Korkmaz

Özdemir

et al. 2021

Mirt

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Objectives: Gastrointestinal bleeding (GIB) is a life-threatening problem that requires a multidisciplinary approach for successful treatment. This study aims to emphasize the clinical contribution of single photon emission computed tomography/computed tomography (SPECT/CT) for the diagnosis of acute bleeding. Methods: All 14 patients referred to the nuclear medicine department in 3 years with suspicion of acute GIB were evaluated retrospectively. Clinical records were analyzed to assess the scintigraphic findings, emphasizing the correlative contribution of the CT portion on SPECT/CT studies. Results: Five patients were negative on dynamic and static planar images. SPECT/CT was performed in 9 patients who had positive findings on planar imaging. SPECT/CT could identify the same bleeding site originating from the anastomosis in four patients with a history of abdominal surgery. SPECT/CT confirmed bleeding from the cecum in a patient with cervical cancer. SPECT/CT showed the bleeding focus in the bladder neck of a patient with bladder cancer and the bleeding from peritoneal metastases of a patient with gastric cancer. In 1 patient, the right upper quadrant activity accumulation, which may cause false positives, was found to be the gallbladder on SPECT/CT. Delayed images showed the true bleeding focus in the cecum. In 1 patient, suspicious activity accumulation in the midline of the abdomen was found to be due to a previously unknown aortic aneurysm on SPECT/CT. Conclusion: SPECT/CT imaging is a feasible technique to facilitate image interpretation in patients with GIB. SPECT/CT imaging can guide the surgeon through more accurate localization. Therefore, for proper patient management, SPECT/CT should be applied to detect the bleeding focus, if present, especially in patients who had undergone a previous operation.

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Section: Discussionmentioning

confidence: 99%

The Diagnostic Contribution of SPECT/CT Imaging in the Assessment of Gastrointestinal Bleeding: Especially for Previously Operated Patients

Demir

Korkmaz

Özdemir

et al. 2021

Mirt

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“…99m Tc-labeled RBC scintigraphy is a very useful method for detecting active GI bleeding; previous studies have reported the sensitivity and specificity of 99m Tc-labeled RBC scintigraphy as 78.6-97 % and 70.4-100 %, respectively [4,5]. However, other studies have reported potential pitfalls, unanticipated and false-positive results, but most of them could be excluded because of untypical patterns of radioactivity [1,[4][5][6][7][8]. The present study could also rule out the possibility of GI bleeding.…”

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confidence: 99%

Inferior Vena Cava Filter Thrombus: a Possible Cause of an Unanticipated Finding of 99mTc-labeled Red Blood Cell Scintigraphy

Song

Choi

Kim

2015

Nucl Med Mol Imaging

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99m Tc-labeled red blood cell scintigraphy, a sensitive and specific diagnostic test, is useful for patients suspected of suffering from active gastrointestinal bleeding. This study follows a case of a patient who was suspected of gastrointestinal bleeding after an inferior vena cava filter was inserted due to a deep vein thrombosis of the femoral vein. To evaluate an exact focus of bleeding, 99m Tc-labeled red blood cell scintigraphy was executed. Herein, an unanticipated finding of 99m Tc-labeled red blood cell scintigraphy probably due to a thrombus on the inferior vena cava filter is reported.Keywords Deep vein thrombosis . Red blood cells . Scintigraphy . Gastrointestinal . BleedingIn November 2014, an inferior vena cava (IVC) filter was inserted in a 64-year-old male because of deep vein thrombosis of the right common femoral vein. He was prescribed 2 mg to 5 mg warfarin to prevent thrombosis from developing. After 2 weeks of taking warfarin, he complained of hematochezia. His hemoglobin levels were 70-90 g/l; gastrointestinal (GI) bleeding was suspected, and warfarin treatment was ceased. Computed tomography (CT) angiography, capsule endoscopy, gastroscopy and colonoscopy were performed, but the tests showed no specific areas of active bleeding. However, they did find ulcers in the cecal area. To identify the focus of the bleeding, 99m Tc-labeled red blood cell (RBC) scintigraphy was executed, and a modified in vitro method was used for RBC labeling. Focal radioactivity appeared in the mid-abdomen area on the 50-min image, remained with no interval change for 4 h, then disappeared on the 21-h image (Fig. 1a). Since this was not a typical pattern of GI bleeding (initial focal activity, increasing activity with time and focus moving in a pattern corresponding to the lumen), GI bleeding could be ruled out [1]. The CT angiography performed 3 days earlier was reviewed retrospectively. The CT angiography showed that an IVC filter existed at the same location as where focal radioactivity appeared in the 99m Tc-labeled RBC scintigraphy (Fig. 1b, c; empty arrows). The authors postulated that a thrombus developed after the injection of 99m Tc-labeled RBC and was caught by the IVC filter because of warfarin management, which had been withdrawn 1 week before, and RBCs were considered to be involved in venous thrombi via passive trapping [2]. It is supposed that the thrombus, located in a lower extremity, rose to the inferior vena cava area after the 40-min image. A possible cause of the disappeared radioactivity on the 21-h image is the thrombus dropping down from the IVC filter after the 4-h image [3]. Consequently, physicians could not find the focus of the bleeding and suspected ulcers of the cecal area. After conservative management, including RBC transfusion, the patient's hemoglobin levels returned to normal. 99m Tc-labeled RBC scintigraphy is a very useful method for detecting active GI bleeding; previous studies have reported the sensitivity and specificity of 99m Tc-labeled RBC scintigraphy as 78.6-...

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Catheter Embolization of Type II Congenital Extrahepatic Portosystemic Shunt with Hematochezia: A Case Series and Review of the Literature

Zhang

et al. 2018

Cardiovasc Intervent Radiol

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Hematochezia is a rare clinical presentation of congenital extrahepatic portosystemic shunt (CEPS). We describe a series of three patients with type II CEPS presenting as hematochezia that were treated by catheter embolization, followed by a brief review of published articles. Hematochezia of the patients was due to the giant inferior mesenteric vein, superior rectal vein and colonic varices. The catheter embolization was successfully accomplished in all of the patients. After a mean follow-up of 27 months, no serious adverse effects were observed. For unexplained massive hematochezia, CEPS needs to be considered as a differential diagnosis. Based on our present results and the review of the literature, transcatheter permanent embolization of the giant inferior mesenteric vein might be an effective and safe treatment for type II CEPS.Level of Evidence Level 4, case series.

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Huge Varicose Inferior Mesenteric Vein: an Unanticipated 99m Tc-labeled Red Blood Cell Scintigraphy Finding

Cited by 5 publications

References 21 publications

The Diagnostic Contribution of SPECT/CT Imaging in the Assessment of Gastrointestinal Bleeding: Especially for Previously Operated Patients

The Diagnostic Contribution of SPECT/CT Imaging in the Assessment of Gastrointestinal Bleeding: Especially for Previously Operated Patients

Inferior Vena Cava Filter Thrombus: a Possible Cause of an Unanticipated Finding of 99mTc-labeled Red Blood Cell Scintigraphy

Catheter Embolization of Type II Congenital Extrahepatic Portosystemic Shunt with Hematochezia: A Case Series and Review of the Literature

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