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Sarcoidosis involving the nervous system probably occurs in about 4% of patients. The usefulness of brain scintigraphy in these cases has been suggested. In this case of cerebral sarcoid granuloma, gallium imaging demonstrated the lesion before treatment and showed disappearance of the lesion after corticosteroid treatment, which correlated with the patient's clinical improvement.
An appendiceal mucocele demonstrated intense early avidity for Ga-67, despite the lack of inflammatory cells to account for the uptake. It is proposed that the acid mucopolysaccharide component of the mucus within the lumen and lining cells accounted for the uptake of the gallium ion, in a similar manner to the uptake of its analogue, the ferric ion, as demonstrated by intense staining of mucus by the colloidal iron technique.
Three of four patients whose cases fit the clinical description of psoas abscess proved on gallium imaging to have infection in the posterior pararenal space sparing the psoas muscle. This space provides a route for spread of infection connecting the spine, the anterior abdominal wall, the scrotum, the anterior thigh, and the gluteal region as demonstrated by the cases presented. Clinical differentiation between posterior pararenal space infection and psoas abscesses is difficult and CT studies may not demonstrate the process when the psoas space is not involved.
Gallium-67 citrate has been known to localize in the lungs in a variety of pulmonary diseases. Abnormal lung activity implies active underlying disease. Serial Ga-67 lung scans may be helpful when steroids are used as therapeutic agents. A case of pulmonary eosinophic granuloma is reported here with diffuse bilateral Ga-67 pulmonary activity.
An Indium-111 labeled white blood cell scan suggested the presence of a pelvic abscess in a woman at four weeks postpartum. This was not identified on a subsequent gallium scan. This discrepancy can be attributed to the normal accumulation of white blood cells within the uterus at one month postpartum.
Skin lymphomas are now divided into "T" or thymic cell lymphomas (mycosis fungoides being the principal type) and "B" cell lymphomas after the bursa of Fabricius. The "T" cell lymphomas all are identified by the thymic or cerebriform cell. Those lymphomas of the skin which do not contain these characteristic cells are derived from the bursa cells and are termed "B" cell lymphomas. A large percentage of these non "T" cell lymphomas have been histologically diagnosed as lymphocytic lymphoma of the skin (1). The authors had an opportunity to scan a patient with histologically proven lymphocytic lymphoma of the skin with Ga-67 and obtained on excellent correlation between gallium accumulation in the skin lesions and histologic confirmation of lymphocytic lymphoma.
In the course of a work-up for fever of unknown origin associated with intermittent arrhythmias, a gallium scan was performed which revealed diffuse myocardial uptake. The diagnosis of Lyme disease myocarditis subsequently was confirmed by serologic titers. One month following recovery from the acute illness, the abnormal myocardial uptake completely resolved.
Accumulation of tracer by the stomach is a frequent incidental occurrence on gallium scans. Gastric concentration of Ga-67 equal to or greater than that seen in the liver was observed in approximately 10% of patients in a large series. Although a few of these patients had known or subsequently demonstrated gastric pathologic conditions, most had no clinically or radiographically identifiable gastric disease.
A case of non-Hodgkin's lymphoma of the abdomen studied by gallium SPECT imaging is reported. The tomographic slices accurately demonstrated the location of residual disease after chemotherapy in the region of the transverse mesocolon. Previous transmission CT had shown considerable persistent retroperitoneal lymphadenopathy, but was not helpful in determining the presence of viable lymphoma.
A case of abnormal uptake of gallium in the tentorium cerebelli secondary to rheumatoid pachymeningitis is presented.
Sporotrichosis is a chronic infection of world wide distribution. It is caused by the diamorphic fungus Sporotrichum schenkii. The multifocal form of sporotrichosis usually involves skin, joints, long bones, lungs, and lymph nodes. Involvement of central nervous system although described is extremely rare. Bone and gallium imaging findings in a case of multifocal systemic sporotrichosis which nicely demonstrated the extensive spread of the disease are presented.
This paper describes the spectrum of extrapulmonary localization of gallium in patients with sarcoidosis. The usefulness of Ga-67 scintiscans in detecting clinically occult lesions, in directing clinicians to accessible sites for biopsy, and in following the course of extrapulmonary sites of involvement with therapy is emphasized.
A patient with medulloblastoma of the cerebellum developed dyspnea and hypoxemia. Pulmonary function tests showed decreased lung volume and diffusing capacity, while the chest radiographs initially showed only mild interstitial infiltrates. Repeated gallium scans showed diffuse lung uptake and diagnosis of pulmonary alveolar proteinosis was made by open lung biopsy.
This case report describes a 43-year-old woman with polycystic renal disease and cyst infection. Infected cysts of the left kidney were successfully localized with Ga-67 citrate SPECT imaging and CT. Other imaging, including planar gallium imaging, was helpful diagnostically, but could not determine the exact location of infection within the kidney.
The clinical records and scintigrams of patients with sickle hemoglobinopathy who underwent combined Tc-99m bone marrow imaging and Ga-67 imaging to differentiate osteomyelitis from bony infarction were reviewed. Of 18 paired examinations in 15 patients, osteomyelitis was diagnosed correctly in six cases; in all six, gallium uptake at the symptomatic site was incongruently increased relative to the bone marrow activity. Of the 12 episodes of infarction, 11 showed congruent activity on both Tc-99m and Ga-67 images. The remaining study was interpreted incorrectly as osteomyelitis due to incongruent Tc-99m and Ga-67 uptake. The use of sequential Tc-99m bone marrow and Ga-67 imaging is an effective means of distinguishing osteomyelitis from bony infarction in patients with sickle hemoglobinopathy.
Ga-67 is known to localize in the lungs in a wide spectrum of pulmonary pathology. The nonspecific affinity of Ga-67 uptake in both inflammatory and neoplastic entities limits its utility in terms of pulmonary disease differential diagnosis. However, Ga-67 lung imaging has proven to be helpful in evaluating the extent of inflammatory activity, as well as in assessing responses to therapy. A case of active chronic berylliosis, a disorder in which Ga-67 uptake has not been previously reported is presented. There is diffuse bilateral Ga-67 pulmonary activity before therapy. Subsequent to steroid therapy, a marked decrease in pulmonary gallium uptake activity was noted with only residual hilar and mediastinal adenopathy noted.
Gallbladder perforation is an unusual condition with a high mortality rate. Early detection with prompt surgical intervention can increase the survival rate. Hepatobiliary imaging using Technetium-99m-labeled iminodiacetic acid has been used for the diagnosis of gallbladder perforation. However, the results vary and are somewhat confusing. The authors report a case of gallbladder perforation with hepatobiliary imaging and an unusual gallium image; review the literature; and propose a classification of three different imaging patterns: 1) visualization of the gallbladder with bile leakage, 2) nonvisualization of the gallbladder with a photopenic fluid collection, and 3) nonvisualization of the gallbladder with bile leakage. These patterns may provide pathophysiologic information for surgeon.
Diffuse lung uptake of gallium-67 citrate was observed in a child with subsequently proven extrinsic hypersensitivity pneumonitis secondary to exposure to bird droppings.