Similar Appearance on Dynamic Images of Meckel Scintigraphy Caused by Different Etiologies: The Value of Lateral Views

Menstruation Confounding the Correct Interpretation of 99m Tc-RBC Bleeding Scan

ABSTRACT

99m Tc-RBC bleeding scan in a 17-year-old adolescent girl showed an increased focal activity in the pelvis. However, SPECT/CT showed that this activity was located in the uterus, which was considered a normal variant considering that the patient was in her fourth day of the menstrual period. Subsequent 99m TcO 4- Meckel scan showed the typical characteristic of ectopic gastric mucosa in the small bowel. Postsurgical pathology confirmed the diagnosis of ectopic gastric mucosa. This case suggested the menstrual period uterus should be included as differential diagnosis of 99m Tc-RBC scan.

Excreted 99m Tc-Pertechnetate in a Renal Pelvis as a Potential False Positive in a Meckel's Scan

ABSTRACT

A 14-year-old girl presented with right lower quadrant pain. A 99m Tc-pertechnetate scan with SPECT/CT was performed to exclude a Meckel's diverticulum. The images demonstrated focal tracer uptake in the right midabdomen, which appeared early and decreased over time. However, SPECT/CT revealed that this uptake corresponded to the right renal pelvis, which was located more inferior than expected. This case emphasizes the importance of recognizing anatomic variants that may cause focal tracer uptake, as well as leveraging an understanding of tracer kinetics to inform a diagnosis.

Potential False-Positive Meckel's Scan Caused by Umbilical Ornamentation

An 18-year-old woman presented to the emergency department for bloody stools. A CT scan of the abdomen ruled out intussusception. Meckel's scan was ordered to rule for Meckel's diverticulum before upper endoscopy and colonoscopy. After proper pretreatment with H2 blocker, Tc-pertechnetate Meckel's scan was performed. Dynamic planar imaging revealed a focus of gradual increase in uptake in midabdomen suggestive of Meckel's diverticulum. A SPECT/CT was done to localize the focus of uptake. Surprisingly, the focus of uptake localized to the periumbilical region on SPECT/CT images. The cause of uptake could be due to local inflammation from umbilical ornamentation.

Obscured Meckel's Diverticulum by the Urinary Bladder: The Value of Lateral View and Post Void Images

We describe a case of a 5-year-old boy with a history of intermittent melena underwent TcO4 scintigraphy. On dynamic images, no abnormal activity was noted. After voiding and also in the lateral view, the focus of activity was noted in the superior and anterior aspect of the urinary bladder, compatible with a Meckel's diverticulum, which was confirmed pathologically as well.