Indian Journal of Nuclear Medicine
Home | About IJNM | Search | Current Issue | Past Issues | Instructions | Ahead of Print | Online submissionLogin 
Indian Journal of Nuclear Medicine
  Editorial Board | Subscribe | Advertise | Contact
Users Online: 470 Print this page  Email this page Small font size Default font size Increase font size


 
 Table of Contents     
INTERESTING IMAGE
Year : 2017  |  Volume : 32  |  Issue : 1  |  Page : 61-62  

Thoraco-Abdominal duplication cyst- role tc-99m pertechnetate spect-ct scintigraphy in localising ectopic gastric mucosa


Department of Nuclear Medicine, SGPGIMS (Sanjay Gandhi Post Graduate Institute of Medical Sciences), Lucknow, Uttar Pradesh, India

Date of Web Publication17-Jan-2017

Correspondence Address:
Sanjay Gambhir
Department of Nuclear Medicine, SGPGIMS, Lucknow, Uttar Pradesh
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-3919.198486

Rights and Permissions
   Abstract 

Thoraco-abdominal duplication cyst, a congenital malformation of the posterior primitive foregut rarely presents with anaemia. Ectopic gastric mucosa is seen in around 20%-30% of the enteric duplication cysts. We report the scintigraphic findings of one such case which helped in final diagnosis and management of the patient.

Keywords: 99mTc pertechnetate, ectopic gastric mucosa, SPECT-CT, Thoraco-abdominal cyst


How to cite this article:
Ravina M, Datta D, Rangan K, Suraj AS, Gambhir S. Thoraco-Abdominal duplication cyst- role tc-99m pertechnetate spect-ct scintigraphy in localising ectopic gastric mucosa. Indian J Nucl Med 2017;32:61-2

How to cite this URL:
Ravina M, Datta D, Rangan K, Suraj AS, Gambhir S. Thoraco-Abdominal duplication cyst- role tc-99m pertechnetate spect-ct scintigraphy in localising ectopic gastric mucosa. Indian J Nucl Med [serial online] 2017 [cited 2019 Dec 12];32:61-2. Available from: http://www.ijnm.in/text.asp?2017/32/1/61/198486

A 3-year-old child presented with history of recurrent epigastric pain for two months with anemia (5.2 g/dl) and fall in haemoglobin. Ultrasound abdomen revealed an echoic cystic lesion adjacent to pancreas and duodenum. Contrast enhanced computerised tomography thorax and abdomen revealed a cystic lesion in the posterior mediastinum extending from the level of arch of aorta through the esophageal hiatus into the lesser sac of the abdomen. Provisional differential diagnosis of pulmonary sequestration / thoraco-abdominal cyst was considered. Tc-99m pertechnetate scintigraphy was performed in view of fall in haemoglobin. Flow and delayed images identified the ectopic mucosa in the thoraco-abdominal cyst [Figure 1] and [Figure 2]. SPECT-CT was further done to confirm the findings [Figure 3]. Following the study, patient underwent posterolateral thoracotomy and exploratoary laparotomy in separate settings. The histo-pathology revealed ectopic gastric muscosa in the cyst [Figure 4].
Figure 1: 99mTc pertechnetate flow images were taken in view of CECT findings of pulmonary sequestration/thoraco-abdominal cyst. The images revealed physiological tracer uptake in the myocardium and stomach. Faint area of tracer uptake noted in the epigastric region adjoining the stomach which increased progressively with time (arrow).

Click here to view
Figure 2: Serial static views were taken at (A) 20 min, (B) 02 h, and (C) 24 h. In image (A), arrow points towards faint tracer uptake in the epigastric region. In image (B), there is linear area of increased tracer uptake noted in the thorax and the abdomen (arrow). (C) 24 h delayed images show persistent increased tracer uptake in the thorax and abdomen with tracer washout from the stomach (arrow).

Click here to view
Figure 3: SPECT-CT images reveal (A) hypodense area in the epigastric region with increased tracer uptake as shown by solid orange arrow in image (C). Physiological uptake in the stomach is noted (yellow arrow). Images (B) and (D) show linear area of increased tracer uptake in the thoracic component of the duplication cyst in the posterior mediastinum .The above-mentioned findings localized the presence of Tc-99m pertechnatate (ectopic gastric mucosa) in the thoraco-abdominal cyst.

Click here to view
Figure 4: Postoperative histopathology of the foregut (thoraco-abdominal)duplication cyst showing lining partly by stratified squamous epithelium. Numerous lymphoid aggregates and mixed inflammatory cell infiltrates are present in the subepithelium (H and E 20X).

Click here to view


Flow and delayed images must be taken to identify ectopic mucosa in duplication cysts as it might only be positive on delayed images in certain cases as in intestinal duplication.[1],[2],[3] Thoraco-abdominal duplication cyst is a congenital malformation of the posterior primitive foregut. Presentation of thoraco-abdominal cyst with anemia is a rare presentation. Ectopic gastric mucosa is seen in around 20%–30% of the enteric duplication cysts.[4],[6],[7]

The above-mentioned findings localized the presence of Tc-99m pertechnatate (ectopic gastric mucosa) in the thoraco-abdominal cyst. Thus, SPECT-CT played an important role in increasing the confidence level and reconfirming the planar scintigraphy findings.[1],[2] Further thoraco-abdominal location of the duplication is extremely rare.[4],[5] It emphasizes on imaging protocols and correct identification of the ectopic mucosa in this setting with SPECT-CT.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Sharma P, Singh H, Nazar AH. 99mTc-pertechnetate SPECT/CT for detecting recurrent foregut duplication cyst in a case with negative planar scintigraphy. Clin Nucl Med 2013;38:641-42.  Back to cited text no. 1
    
2.
Kumar R, Dasan JB, Chandrashekar N. Diagnosis of ectopic gastric mucosa using 99Tcm-pertechnetate: Spectrum of scintigraphic findings. Br J Radiol 2005;78:714-20.  Back to cited text no. 2
    
3.
Singal AK, Bhatnagar V, Mitra DK. Oesophageal duplication cyst causing neonatal haemoptysis. Trop Gastroeneterol 2004;25:99-100.  Back to cited text no. 3
    
4.
Kumar K, Dhull VS, Karunanithi S. Synchronous thoracic and abdominal enteric duplication cysts: Accurate detection with 99mTc-pertechnetate scintigraphy. Indian J Nucr Med 2015;30:59-61.  Back to cited text no. 4
    
5.
Kiratli PO, Aksoy T, Bozkurt MF. Detection of ectopic gastric mucosa using 99mTc pertechnetate: reiview of literature. Ann Nucl Med 2009;23:97-105.  Back to cited text no. 5
    
6.
Gross RE, Holcomb GW, Jr Farber S. Duplications of the alimentary tract. Pediatrics 1952;9:448-68.  Back to cited text no. 6
    
7.
Bower RJ, Sieber WK, Kiesewetter WB. Alimentary tract duplications in children. Ann Surg 1978;188:669-74.  Back to cited text no. 7
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

Top
  
 
  Search
 
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    Abstract
    References
    Article Figures

 Article Access Statistics
    Viewed642    
    Printed5    
    Emailed0    
    PDF Downloaded69    
    Comments [Add]    

Recommend this journal