Indium-111 Pentetreotide Lung Uptake in Infectious Lung Disease

Abstract

Bilateral diffuse lung uptake of In-111 pentetreotide (OCT) was observed during a whole-body scan performed in a 68-year-old woman with Cushing's syndrome and suspected ectopic adrenocorticotropic hormone secretion. A few days later, she was found to have bilateral bacterial pneumonia (of mixed anaerobic origin). Cushing's syndrome was finally proved to be of pituitary origin. The OCT lung uptake in pneumonia probably resulted from tracer binding by somatostatin receptors on the inflammatory leukocytes. Although the rapid wash-out from experimentally induced abscesses does not make OCT a suitable tracer for detecting acute infections, the images and data here reported suggest that infectious lung disease should be excluded before diagnosing lung involvement by neuroendocrine tumors.

Octreoscan in patients with bronchial carcinoid tumours

“…Because metastases from bronchial carcinoids may occur late, it is important to observe the patients for a long time and to undertake repeated octreoscan examinations. However, octreoscan can not be used for differential diagnosis of a lesion found on chest X‐ray or CT, as both sarcoidosis (Kwekkeboom et al ., 1998) and pneumonias (Castellani et al ., 1999) may be visualized on octreoscan, and the thoracic lesions of small cell lung carcinomas are generally detectable (O’Byrne et al ., 1994; Berenger et al ., 1996; Reisinger et al ., 1998). Moreover, in one study, 10/10 nonsmall cell lung carcinomas were octreoscan‐positive (Lau et al ., 2000).…”

“…Diseases other than neuroendocrine tumours that may be positive on octreoscan include meningeomas (Krenning et al ., 1995), granulomatous diseases, e.g. sarcoidosis (Kwekkeboom et al ., 1998), malignant lymphomas (Reubi et al ., 1992) and Graves' disease (Postema et al ., 1994), but also pneumonias (Castellani et al ., 1999). Some case reports claim that somatostatin receptor scintigraphy is positive in patients with occult ACTH-producing tumours with Cushing's syndrome (Phlipponneau et al ., 1994;Weiss et al ., 1994;Carretta et al ., 1997;Mansi et al ., 1997).…”

Pneumonia can cause 111Indium octreotide uptake

“…Octreotide uptake also occurs in the nasal region and lung hila in individuals with upper respiratory tract infections (URTI) and influenza, post‐lung irradiation or after the administration of bleomycin 7 and in hypersensitivity pneumonitis caused by fungal infection 8 . We were able to identify only a single report of diffuse uptake in the lungs of an elderly woman with bilateral bacterial pneumonia 9 …”

“…8 We were able to identify only a single report of diffuse uptake in the lungs of an elderly woman with bilateral bacterial pneumonia. 9 Eventration as a cause of thoracic uptake has also been reported. A patient undergoing 111 In octreotide scan for assessment of a possible gastrinoma showed increased uptake in the chest on the left side.…”

False-positive 111 In-pentetreotide Uptake in Gastritis

“…[6] Bilateral diffuse lung uptake of In-111 pentetreotide was also observed during a whole-body scan performed in a 68-year-old woman with Cushing's syndrome and suspected ectopic adrenocorticotropic hormone secretion. [7] Yenson et al . in their study have reported a case of an 18-year-old woman which underwent an 111 In octreotide scan for evaluation of a possible insulinoma.…”