Intrathoracic stomach mimicking bone metastasis from thyroid cancer in whole-body iodine-131 scan diagnosed by SPECT/CT

Abstract

SUMMARYThe whole-body iodine-131 scintigraphy is an imaging technique in monitoring patients with a history of thyroid cancer. Although the rate of false positives is negligible, it is not nonexistent. We report the case of an intervened and treated patient for thyroid cancer with good clinical and biochemical response. Scintigraphic findings were consistent with unsuspected bone metastasis. Fused SPECT/CT data allowed accurate diagnosis of giant diaphragmatic hernia associated with intrathoracic stomach, a very rare pathology that can lead to false positive results. Arch Endocrinol Metab. 2017;61(3):288-90. Subsequently, a single photon emission computed tomography/computed tomography (SPECT/CT) was performed due to discordance between biochemical findings (low hormone levels) and the clinical picture of intense back pain and functional imaging consistent with spine bone metastasis. A severe thoracolumbar scoliosis that determines a giant diaphragmatic hernia was revealed thanks to multimodality scan (Figure 2). Thereby, high intense hypermetabolic foci corresponded to physiological activity of the improperly positioned gastric mucosa mimicking bone metastasis.