Incidental Detection of Malignant Pleural Effusion on Sestamibi Myocardial Perfusion Scan

Abstract

Incidentally the diagnosis of pleural effusions can be made with scintigraphic studies. We report a case of incidental detection of pleural effusion in sestamibi myocardial perfusion scan. A 64-year-old man with a history of chest pain was referred for Sestamibi myocardial perfusion scintigraphy. The review of cine data revealed an area of radiotracer accumulation in the left hemithorax. Subsequent chest X-ray and computed tomography revealed a relatively massive pleural effusion. Microscopic evaluation confirmed the malignant nature of pleural effusion, the origin of which was an ipsilateral pulmonary adenocarcinoma. As to our knowledge, it is the first report of sestamibi uptake in pleural effusion fluid. In our opinion, this finding could be explained by radiotracer uptake in the malignant component of the effusion. Reporting of these incidental findings could be important and sometimes can be resulted in determining previously unknown pathologies.

Importance of systematic review of rotating projection images from Tc99m-sestamibi cardiac perfusion imaging for noncardiac findings

“…Among these are focal liver photopenia representing colon cancer metastasis [2], diffuse appendicular skeleton uptake representing multiple myeloma [3,4], focal thyroid uptake representing Hurthle cell carcinoma [5], anterior mediastinal activity representing malignant thymoma [6], and focal lung uptakes representing bronchogenic carcinoma [7,8], ectopic parathyroid adenoma [9], and carcinoid [10]. In addition, there is a growing collection of reports describing non-neoplastic NCF, such as pleural effusions [11,12], pericardial effusions [13,14], large ovarian cyst [15], large liver cyst [16], large renal cysts [17], large hiatal hernia [17,18], cholecystitis [19,20], lactation [21], gastric wall uptake [22], benign lung nodules [23], acute pulmonary embolism [24], ascites [25,26], gastric reflux [27], and nonspecific dyspepsia [22]. Shih provides good reviews of many of these pathologies on myocardial perfusion imaging (MPI) studies using Tc99m-tetrofosmin [28] and Tl-201 [29].…”

An important but easily forgettable review: extracardiac activity in myocardial perfusion scans

“…If we have had a bird eye view of the previous articles concerning extracardiac activity in the myocardial perfusion scans, we would find numerous reports regarding the fact which extracardiac activities have been observed in the myocardial scintigraphy [1][2][3][4][5][6][7][8]. Most of the authors in such reports have recommended to review of cinematic projections in order to finding extracardiac activities [2,[6][7][8].…”

“…Most of the authors in such reports have recommended to review of cinematic projections in order to finding extracardiac activities [2,[6][7][8]. Perhaps the reason for such repeated emphasis is that nuclear medicine specialists in their daily practices forget to review cinematic projections.…”

“…These noncardiac diseases occasionally mimic the cardiac symptoms. Some of such diseases include gastric disease [6,7], liver and gallbladder disease [1], spleen disorders [1], vertebral pathologies [1] and pulmonary pathologies [8]. Regarding this fact that thallium and sestamibi are tumoral avid agents, it is not surprising that several tumors in old people (it implies that the age at which the prevalence of cardiac diseases increase, the demand for myocardial perfusion scintigraphy increase proportionally) discovered incidentally.…”