Extracardiac Uptake on Myocardial Perfusion Imaging in a Patient With Diaphragmatic Paralysis and Chilaiditi's Sign

Abstract

We present a rare case of extracardiac activity in right hemitorax secondary to the Chilaiditi sign and diaphragmatic paralysis due to right hemiplegia identified incidentally during myocardial perfusion scintigraphy. A 77-year-old man with right hemiplegia suspected of having ischemic heart disease, was admitted for myocardial perfusion scintigraphy studies. On raw data images, intense bowel uptake in the right hemithorax was visualized. Chest radiography and CT images of the patient were evaluated and Chilaiditi sign was found. This sign is a relatively rare condition with an incidence ranging between 0.025% and 0.28%, considered as a normal variant. REFERENCES1. Vijayakumar V, Gupta R, Rahman A. Pathologic extracardiac uptake of Tc-99m tetrofosmin. J Nucl Cardiol. 2005;12:473-475. 2. Slavin JD Jr, Engin IO, Spencer RP. Retrocardiac uptake of Tc-99m sestamibi: manifestation of a hiatal hernia. Clin Nucl Med. 1998;23:239 -240. 3. Gratz S, Kempke B, Kaiser W, et al. Tumor uptake during myocardial perfusion scintigraphy. Nucl Med Commun. 2008;29:963-969. 4. Gedik GK, Ergün EL, Aslan M, et al. Unusual extracardiac findings detected on myocardial perfusion single photon emission computed tomography studies with Tc-99m sestamibi. Clin Nucl Med. 2007;32:920 -926. 5. Spieth ME, Kasner DL, Bull MP. diaphragmatic paralysis with an elevated hemidiaphragm masquerading as lung carcinoma found during myocardial perfusion imaging. Clin Nucl Med. 2002;27:903-904. 6. Jones SE, Aziz K, Yasuda T, et al. Importance of systematic review of rotating projection images from Tc-99m-sestamibi cardiac perfusion imaging for noncardiac findings. Nucl Med Commun. 2008;29:607-613. 7. Tzimas T, Baxevanos G, Akritidis N. Chilaiditi's sign. Lancet. 2009;373:836. 8. Haddad CJ, Lacle J. Chilaiditi's syndrome. A diagnostic challenge. Postgrad Med. 1991;89:249 -250.