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History of Present Illness: The
patient is a 72 year old black female with a chief complaint of nausea
and vomiting, weakness, and shortness of breath.
Past Medical History:
- Breast Cancer with lumpectomy on the
right side and a lymph node dissection.
- Hypothyroidism
Social History:
Patient does not smoke, but uses tobacco occasionally. No
alcohol or IV drugs.
Medications Prior
to Admission: Levothroxine and Avalide
Nuclear Medicine Studies:
Patient has a large substernal thyroid and shortness of breath.
A parathyroid scan was ordered to rule out parathyroid adenoma.
24.4 mCi of Tc-Sestamibi was injected I.V. and and the thyroid was
scanned with standard projections at 15 minutes, 90 minutes, and 3
hours.
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15
minutes |
90
minutes |
3
hour image |
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There is a large area
of increased uptake in the neck especially on the left which extends
inferiorly into the mediastinum. This is consistant with a
large goiter and correlates with a CT scan done previously. On
the 3 hour scan, a small focal area of increased tracer activity is
seen in the left side of the neck which may represent a parathyroid
adenoma, however because of the large thyroid enlargement on the
left this finding is not conclusive.
A cardiac output study was performed
and it demonstrated diffuse LV hypokinesia with an ejection fraction
of 20% (normal >50%) and a dilated left ventricle.
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Images courtesy of UAMS Dept of
Nuclear Medicine.
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