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HISTORY: The patient is
a 52 year old male newly diagnosed with lung cancer. He
presents to the nuclear medicine department for a pre-surgical
workup prior to surgery and cancer treatment.
RADIOLOGY REPORT:
PERSANTINE SESTAMIBI STRESS TEST
CLINICAL INDICATION: Preoperative for thoracotomy, cigarette smoker.
PROCEDURE: After obtaining informed consent, patient was infused
intravenously with 43-mg of Persantine over 4-minutes. Stress dose
of the radiotracer was injected intravenously at 7-minutes into the
infusion and the Persantine was reversed at 8 1/2-minutes with
100-mg of Aminophylline.
FINDINGS: The heart rate fell from 107 to 101 beats per minute.
Blood pressure rose from 114/70 to 122/76 millimeters of mercury.
Patient had some tired feeling in his chest but had no changes from
baseline EKG.
IMPRESSION:
1. BLUNTED, POSSIBLY PARADOXICAL HEMODYNAMIC RESPONSE TO THE
PERSANTINE. THIS MAY REDUCE THE SENSITIVITY OF THE STUDY.
MYOCARDIAL PERFUSION IMAGING: Rest and gated stress Persantine
Sestamibi stress testing is performed per protocol using 10.08-mCi
of technetium 99m Sestamibi at rest and 34.5-mCi at stress.
FINDINGS: Rest and stress tomographic imaging show a tiny perfusion
defect at the apical tip, which has an apparent reversibility.
Otherwise, there was fixed mildly reduced activity in the
anteroseptal segment. No reversible defects were seen.
CINE of the raw data also shows a focus of increased activity
superior and lateral to the left ventricle. This appears to have a
photopenic center. The slices also document this focus. This is
consistent with the patient's known lung cancer.
IMPRESSION:
1. NO ISCHEMIA IS SEEN. THE FOCUS OF APPARENT REVERSIBILITY IN THE
APEX IS VERY SMALL (LESS THAN 2% OF LEFT VENTRICLE) AND IS FELT TO
BE DUE TO APICAL THINNING. FIXED REDUCTION ACTIVITY IN THE
ANTEROSEPTAL SEGMENT CAN BE INSERTION OF THE RIGHT VENTRICLE.
SUBENDOCARDIAL SCARRING THAT IS FELT TO BE LESS LIKELY.
A RELATIVELY
LARGE FOCUS IS NOTED SUPERIOR AND LATERAL TO THE HEART AND IS
PROBABLY THE PATIENT'S KNOWN LUNG CANCER.
QUANTITATIVE FUNCTIONAL IMAGING: The stress tomographic images were
acquired by the gated technique.
FINDINGS: The ejection fraction is 41%. End diastolic volume is
137-ml. CINE of the slices shows no segmental wall motion
abnormalities.
IMPRESSION:
1. MILD LEFT VENTRICULAR PUMP FAILURE WITH LEFT VENTRICULAR
DILATION. NO SEGMENTAL WALL MOTION ABNORMALITIES ARE SEEN.
BACK
© 2005 Nuclear Education Online
- Images courtesy of University
of Arkansas for Medical Sciences Dept of Nuclear Medicine.
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