Incidental massive pericardial effusion diagnosed by myocardial perfusion imaging

Massive pericardial effusion: A rare and easily missed finding in myocardial perfusion scintigraphy

A 72-year-old gentleman underwent myocardial perfusion scintigraphy (MPS) for sinus tachycardia of unknown cause. Baseline electrocardiography (ECG) showed sinus tachycardia and electrical alternans. Thallium-201 stress-redistribution MPS was performed with dipyridamole stress. On the raw projection images, a photopenic "halo" was noted surrounding the heart. Reconstructed slices showed small left ventricle with no obvious perfusion defect. Review of single-photon emission computed tomography/computed tomography images showed suspected large pericardial effusion. The patient was admitted and Echocardiography showed significant circumferential pericardial effusion with early tamponade effect. Subsequent bedside pericardiocentesis aspirated 800 ml blood-stained fluid and the cytology yielded metastatic adenocarcinoma with features suggestive of pulmonary primary. Pericardial effusion is a rare finding in MPS. Finding of a "halo" around the heart should raise suspicion on the presence of pericardial effusion and confirmatory investigation such as ECG may be warranted.

Incidental detection of malignant pleural effusion on sestamibi myocardial perfusion scan

Incidentally the diagnosis of pleural effusions can be made with scintigraphic studies. We report a case of incidental detection of pleural effusion in sestamibi myocardial perfusion scan. A 64-year-old man with a history of chest pain was referred for Sestamibi myocardial perfusion scintigraphy. The review of cine data revealed an area of radiotracer accumulation in the left hemithorax. Subsequent chest X-ray and computed tomography revealed a relatively massive pleural effusion. Microscopic evaluation confirmed the malignant nature of pleural effusion, the origin of which was an ipsilateral pulmonary adenocarcinoma. As to our knowledge, it is the first report of sestamibi uptake in pleural effusion fluid. In our opinion, this finding could be explained by radiotracer uptake in the malignant component of the effusion. Reporting of these incidental findings could be important and sometimes can be resulted in determining previously unknown pathologies.