Periumbilical uptake of Tc-99m MAA on lung perfusion scanning in a patient with superior vena cava obstruction.
A 25-year-old woman with severe parenchymal lung disease of unknown etiology and existing for more than a decade was referred for ventilation-perfusion scintigraphy because of suspicion of pulmonary embolism. Both ventilation and perfusion images showed, apart from perfusion defects from her severe lung disease, a left apical pneumothorax and signs of recurrent pneumonia of the left lower lobe. Noteworthy was the periumbilical uptake of the Tc-99m macroaggregated albumin (MAA). Her medical history revealed iatrogenic superior vena cava (SVC) obstruction. In this case, the main collateral pathway of portosystemic shunting is probably, after recanalization of the left umbilical vein, a network of smaller paraumbilical veins.
Department of Nuclear Medicine, Medical Center, Leeuwarden, The Netherlands. hans.balink@znb.nl
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Balink
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Nabers
D000328:Adult; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D011014:Pneumonia / Q000000981:diagnostic imaging; D011030:Pneumothorax / Q000000981:diagnostic imaging; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals / Q000493:pharmacokinetics; D013479:Superior Vena Cava Syndrome / Q000000981:diagnostic imaging*; D013668:Technetium Tc 99m Aggregated Albumin / Q000493:pharmacokinetics; D014472:Umbilicus / Q000098:blood supply* / Q000000981:diagnostic imaging*
D019275:Radiopharmaceuticals; D013668:Technetium Tc 99m Aggregated Albumin