Presentation
The patient had a history of gastric carcinoma in 2008 and underwent Billroth 2 surgery. They have been compliant with hematinic and B12 injections. However, they have developed recurrent anemia over the past 2 years. Esophagogastroduodenoscopy (OGDS) and colonoscopy have been performed, and the results are normal. These procedures were conducted to rule out gastrointestinal bleeding.
Patient Data
Persistent, diffuse tracer uptake in the middle of the thorax. The uptake is not increasing with time in the dynamic images, which corresponds to physiological tracer uptake in the large vessels and myocardium, as collaborated by SPECT-CT images.
No significant focal tracer uptake was seen in the bowel to suggest bleeding during the dynamic phase and delayed static images at 1 hour.
SPECT CT images also show no suspicious tracer uptake in the abdomen and pelvis.
Normal tracer activity in the liver, spleen, large vessels, kidney, and bladder.
Case Discussion
The radiopharmaceuticals used are Tc99m stannous pyrophosphate (PYP) 10 mCi and Technetium-99m labeled red blood cells (RBCs). The red blood cells are labeled using the in vitro method.
The following views are taken: anterior and posterior projection, flow, and static views at 1 hour with SPECT-CT thorax and abdomen.
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