Large abdominal photopenic area on 99mTc-sestamibi myocardial perfusion imaging.

(99m)Tc-sestamibi myocardial perfusion imaging is frequently performed in conjunction with exercise or pharmacologic stress testing for evaluation of coronary heart disease. Interpretation of these studies includes systematic review of unprocessed rotating projectional images for evaluation of cardiac size as well as the presence of motion or attenuation artifacts. Occasionally, incidental noncardiac findings are detected on review of the projectional images.

Could it be coronary-subclavian steal syndrome?

A patient with history of coronary bypass surgery was admitted with chest discomfort and noted to have decreased left arm blood pressure. She was found to have severe subclavian artery stenosis causing coronary-subclavian steal syndrome. Subclavian stenting led to resolution of symptoms and normalization of blood pressure.