sodium-pertechnetate-tc-99m and Deglutition-Disorders

The principal radionuclide procedures involved in the evaluation of esophageal disorders that are amenable to surgery are illustrated and briefly described. The role of the radionuclide esophagogram (RE) in the diagnosis and management of achalasia, oculopharyngeal muscular dystrophy and its complications, tracheoesophageal fistulae, pharyngeal and esophageal diverticulae, gastric transposition, and fundoplication is discussed. Detection of columnar-lined esophagus by Tc-99m pertechnetate imaging and of esophageal carcinoma by Ga-67 citrate and Tc-99m glucoheptonate studies also is presented.

Topics: Barrett Esophagus; Deglutition Disorders; Diverticulum, Esophageal; Esophageal Achalasia; Esophageal Diseases; Esophageal Neoplasms; Esophagus; Gallium Radioisotopes; Gastroesophageal Reflux; Humans; Muscular Dystrophies; Organotechnetium Compounds; Radionuclide Imaging; Rhenium; Sodium Pertechnetate Tc 99m; Stomach; Sugar Acids; Technetium; Technetium Tc 99m Sulfur Colloid; Tracheoesophageal Fistula

Approximately 30% of patients with motor neuron disease (MND) present swallowing difficulties even in early disease stages. The aim of this study was to examine the usefulness of esophageal scintigraphy in detecting early stage of dysphagia in MND.. Esophageal scintigraphy (ES) including mean transit time (MTT) estimation was performed in 121 MND patients presenting various levels of upper (UMN) and lower motor neuron (LMN) degeneration.. ES detected dysphagia in more than 80% of MND patients who had referenced swallowing difficulties. In MND patients with ES-confirmed dysphagia, the MTT was increased approximately 2-fold without significant differences between the clinical phenotypes. The MTT was significantly longer in patients with bulbar-pseudobulbar syndrome in comparison to patients with isolated pseudobulbar syndrome, which indicates a higher involvement of the LMN deficiency in developing dysphagia in MND. The esophageal passage in MND was not dependent on age, sex, disease duration, or diagnosis delay. Interestingly, ES was also able to detect dysphagia in almost 70% of MND individuals who had no swallowing complaints (subclinical dysphagia). A more benign disease course and a higher percentage of male patients characterized this group.. Esophageal scintigraphy is a helpful screening tool in determining early swallowing impairment in a high percent of patients with MND of various clinical phenotypes.

Topics: Adult; Aged; Deglutition Disorders; Female; Humans; Male; Middle Aged; Motor Neuron Disease; Positron-Emission Tomography; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m

Thyroid hemiagenesis (TH) is a rare congenital abnormality in which one thyroid lobe fails to develop. Its prevalence is uncertain, because the absence of one thyroid lobe does not usually cause clinical symptoms. The detection of TH is usually incidental when the evaluation of other thyroid disorders is requested. It is more frequently found in female than in male patients (3:1 ratio) and in the left lobe compared to the right lobe. We report the case of a 54-yr-old man, presenting with a large multinodular right-sided goiter, with mediastinal extension and dysphagia. Thyroid scan and ultrasound study showed the absence of the left lobe. The patient underwent surgery for compressive symptoms, and the operation confirmed the absence of the left lobe. Histological examination demonstrated a multi-nodular goiter with papillary carcinoma. To our knowledge, this case represents the first reported case of association between TH and papillary thyroid carcinoma in a male patient, and the second in which the tumor arose in the right lobe.

Topics: Carcinoma, Papillary; Deglutition Disorders; Goiter; Humans; Male; Middle Aged; Positron-Emission Tomography; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Thyroid Gland; Thyroid Neoplasms; Thyroidectomy; Ultrasonography

We present the case of a 41-year-old man admitted to the hospital with fever and toxic syndrome possibly having an oncological or infectious origin. A whole body scan with 67Ga-citrate showed an intense and diffuse radiotracer accumulation in the thyroid gland. The patient was re-evaluated and studied with other diagnostic tests including a thyroid 99mTc-pertechnetate scintigraphy and a thyroidal radioiodine uptake. A correct final diagnosis of painless subacute thyroiditis was made.

Topics: Adult; Anorexia; Citrates; Deglutition Disorders; Diagnosis, Differential; Diagnostic Errors; Fever; Gallium; Gallium Radioisotopes; Humans; Iodine Radioisotopes; Male; Paraneoplastic Syndromes; Pharyngitis; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Thyroiditis, Subacute; Tuberculosis

Patients with Parkinson's disease often experience dysphagia, in which case food seems to be blocked in the throat. The patient must swallow over and over to get it down. A radionuclide solid phase esophageal motility study was conducted to evaluate esophageal function of patients with Parkinson's disease. Twenty-seven patients and 27 age-matched normal volunteers were studied. Each subject was placed in the supine position above a gamma camera linked to a computer and was given a 4 mL bolus of solid gelatin containing 75 MBq Tc-99m pertechnetate. Data were acquired in the list mode. A computer routine was used to calculate the total mean transit time, the residual fraction after the first swallow, and the retrograde index. The preliminary results suggest: 1) patients with Parkinson's disease display significantly slowed transit time when compared with normal age-matched controls, and 2) dysphagia of Parkinson's disease may improve with medication. A solid phase esophageal motility study may be used as a monitor of dysphagia in patients with Parkinson's disease in our future studies.

Topics: Aged; Deglutition Disorders; Esophagus; Female; Gastrointestinal Transit; Humans; Male; Parkinson Disease; Peristalsis; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

Twenty-five patients with oropharyngeal dysphagia due to a variety of disorders (4 with muscular dystrophy, 4 with myasthenia gravis and 13 with inflammatory myopathies) were studied clinically by esophageal manometry and isotopic clearance. Clinically patients had moderate dysphagia and 45% other symptoms such as nasal regurgitation, bronchial aspiration, etc. The most important manometric abnormality was the feeble contractions of the pharyngeal musculature, more pronounced in patients with severe dysphagia (grade II). Isotopic clearance of the oropharynx showed slowing of the pharyngeal emptying curve and an increased residual activity in this area. Isotopic oropharyngeal clearance is a useful, comfortable and noninvasive test for determining the clinical improvement which accompanies the manometric recovery of the pharyngeal muscular contraction.

Topics: Deglutition Disorders; Humans; Manometry; Oropharynx; Pharyngeal Muscles; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

Topics: Adult; Deglutition Disorders; Esophagus; Female; Humans; Male; Radionuclide Imaging; Scleroderma, Systemic; Sodium Pertechnetate Tc 99m; Technetium