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Thoraco-Abdominal Duplication Cyst- Role Tc-99m Pertechnetate SPECT-CT Scintigraphy in Localising Ectopic Gastric Mucosa
Address of correspondence: Professor and Head Sanjay Gambhir, Department of Nuclear Medicine, SGPGIMS, Lucknow, Uttar Pradesh, India E-mail: gaambhir@yahoo.com
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Abstract
Thoraco-abdominal duplication cyst, a congenital malformation of the posterior primitive foregut rarely presents with anaemia. Ectopic gastric mucosa is seen in around 20%-30% of the enteric duplication cysts. We report the scintigraphic findings of one such case which helped in final diagnosis and management of the patient.
Keywords
99mTc pertechnetate
ectopic gastric mucosa
SPECT-CT
Thoraco-abdominal cyst
A 3-year-old child presented with history of recurrent epigastric pain for two months with anemia (5.2 g/dl) and fall in haemoglobin. Ultrasound abdomen revealed an echoic cystic lesion adjacent to pancreas and duodenum. Contrast enhanced computerised tomography thorax and abdomen revealed a cystic lesion in the posterior mediastinum extending from the level of arch of aorta through the esophageal hiatus into the lesser sac of the abdomen. Provisional differential diagnosis of pulmonary sequestration / thoraco-abdominal cyst was considered. Tc-99m pertechnetate scintigraphy was performed in view of fall in haemoglobin. Flow and delayed images identified the ectopic mucosa in the thoraco-abdominal cyst [Figures 1 and 2]. SPECT-CT was further done to confirm the findings [Figure 3]. Following the study, patient underwent posterolateral thoracotomy and exploratoary laparotomy in separate settings. The histo-pathology revealed ectopic gastric muscosa in the cyst [Figure 4].
Flow and delayed images must be taken to identify ectopic mucosa in duplication cysts as it might only be positive on delayed images in certain cases as in intestinal duplication.[123] Thoraco-abdominal duplication cyst is a congenital malformation of the posterior primitive foregut. Presentation of thoraco-abdominal cyst with anemia is a rare presentation. Ectopic gastric mucosa is seen in around 20%–30% of the enteric duplication cysts.[467] The above-mentioned findings localized the presence of Tc-99m pertechnatate (ectopic gastric mucosa) in the thoraco-abdominal cyst. Thus, SPECT-CT played an important role in increasing the confidence level and reconfirming the planar scintigraphy findings.[12] Further thoraco-abdominal location of the duplication is extremely rare.[45] It emphasizes on imaging protocols and correct identification of the ectopic mucosa in this setting with SPECT-CT.
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Conflict of interest
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References
- 99mTc-pertechnetate SPECT/CT for detecting recurrent foregut duplication cyst in a case with negative planar scintigraphy. Clin Nucl Med. 2013;38:641-42.
- [Google Scholar]
- Diagnosis of ectopic gastric mucosa using 99Tcm-pertechnetate: Spectrum of scintigraphic findings. Br J Radiol. 2005;78:714-20.
- [Google Scholar]
- Oesophageal duplication cyst causing neonatal haemoptysis. Trop Gastroeneterol. 2004;25:99-100.
- [Google Scholar]
- Synchronous thoracic and abdominal enteric duplication cysts: Accurate detection with 99mTc-pertechnetate scintigraphy. Indian J Nucr Med. 2015;30:59-61.
- [Google Scholar]
- Detection of ectopic gastric mucosa using 99mTc pertechnetate: reiview of literature. Ann Nucl Med. 2009;23:97-105.
- [Google Scholar]