Unsuspected Accessory Ossicle in Possible Sinus Tarsi Syndrome: The Value of Bone SPECT/CT.

Three-phase bone scan was performed for evaluation of possible sinus tarsi syndrome in a 52-year-old man with chronic left ankle pain. MRI was initially read as unremarkable, and there was little symptomatic improvement after intra-articular anesthetic injection. The primary finding that appreciated only delayed bone SPECT/CT images was focal increased uptake associated with a well-corticated 8-mm bony fragment adjacent to the left calcaneus, thought to represent an accessory ossicle within the left sinus tarsi.

Clinical Significance of a Solitary Cold Thyroid Nodule in the Setting of Graves Disease.

I-NaI thyroid uptake and scan in a 46-year-old woman with symptomatic hyperthyroidism demonstrated marked, diffusely increased uptake consistent with Graves disease, as well as a solitary hypofunctioning ("cold") nodule. Pathologic evaluation following total thyroidectomy and selective neck dissection revealed invasive multifocal papillary thyroid carcinoma in a background of Graves disease and 5 of 36 lymph nodes positive for metastatic disease. This case serves as a reminder that when present a cold nodule in the setting of Graves disease warrants further evaluation for underlying malignancy.

Concurrent Diffuse Pyelonephritis and Prostatitis: Discordant Findings on Sequential FDG PET/CT and 67Ga SPECT/CT Imaging.

A 45-year-old man underwent FDG PET/CT for initial imaging evaluation of recurrent Escherichia coli urinary tract infections, which demonstrated no significant FDG uptake in either kidney and subtle FDG uptake in the right prostate lobe. Subsequent Ga SPECT/CT demonstrated abnormal intense gallium uptake throughout the right kidney and entire prostate gland, clearly discordant with PET/CT findings and consistent with unexpected concurrent pyelonephritis and prostatitis. Although FDG has effectively replaced Ga in everyday clinical practice, the current case serves as a reminder that there is still a role for Ga in the evaluation of genitourinary infections.

Facial Paralysis Secondary to Extensive Perineural Spread of Adenocarcinoma of the Parotid Gland Identified by PET/CT.

Brain MRI in an 82-year-old man with presumed Bell's palsy revealed a clinically unsuspected right parotid gland mass but no other acute findings. Biopsy revealed poorly differentiated adenocarcinoma. Staging F-FDG PET/CT revealed an FDG-avid parotid mass, abnormal FDG uptake along the course of the facial nerve from mass to skull base, and multiple FDG-avid right level II neck lymph nodes and hepatic metastases.

Serendipitous discovery of non-sestamibi-avid squamous cell lung cancer invading the heart during myocardial perfusion imaging.

Scintigraphic and radiographic correlation of a non-sestamibi-avid lung mass invading the left ventricle serendipitously discovered during adenosine myocardial perfusion imaging is presented. The only clue to the presence of the mass was deformation of the anterior wall on SPECT myocardial perfusion imaging. This case serves as a reminder that although the appearance of pathology on a nuclear medicine imaging study is typically what is seen (specifically, increased radiopharmaceutical uptake), it can just as importantly be what is not seen.