sodium-pertechnetate-tc-99m and Esophageal-Achalasia

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

We report the case of a 49-year-old woman with achalasia in whom thyroid stimulating hormone supression was incidentally detected on routine blood tests and who therefore underwent thyroid scintigraphy. Thyroid scan demonstrated low intensity diffuse technetium Tc sodium pertechnetate accumulation inferior to thyroid gland. After correlating the images with her previous barium esophagogram, tracer accumulation caudal to thyroid gland was explained on the presumption of Tc sodium pertechnetate retention within the dilated esophagus.

Topics: Esophageal Achalasia; Female; Humans; Incidental Findings; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Thyroid Gland; Tomography, X-Ray Computed

Topics: Adolescent; Esophageal Achalasia; Esophagogastric Junction; Female; Humans; Iodine Radioisotopes; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Sodium Iodide; Sodium Pertechnetate Tc 99m; Thyroid Gland

A 73-year-old patient presented a 99mTc scintiscan with a focal tracer accumulation left and caudal of the thyroid gland. Further investigations with sonography, CT, esophagoscopy and barium swallow provided the diagnosis of achalasia as the reason for focal 99mTc retention caudal of the thyroid gland. Explanation for 99mTc accumulation within the esophagus may be the nonspecific accumulation of 99mTc not only in the thyroid gland but also in the salivary glands. Excretion of the tracer follows with the saliva. Structural and motor disorders of the esophagus can thus lead to focal tracer retention within the esophagus simulating thyroid tissue.

Topics: Aged; Barium Sulfate; Catheterization; Esophageal Achalasia; Esophagoscopy; Female; Humans; Salivary Glands; Sodium Pertechnetate Tc 99m; Thyroid Gland; Tomography, Emission-Computed; Tomography, X-Ray Computed

The esophagus was evaluated in 15 patients with achalasia by continuous gamma camera imaging following ingestion of a semi-solid meal labeled with 99mTc. The images were displayed and recorded on a simple computerized data processing/display system. Subsequent ciné mode images of esophageal emptying demonstrated abnormalities of the body of the esophagus not reflected by the manometric examination. Computer-generated time-activity curves representing specific regions of interest were better than manometry in evaluating the results of myotomy, dilatation, and drug therapy. Isosorbide dinitrate significantly improved esophageal emptying.

Topics: Adolescent; Adult; Aged; Child; Esophageal Achalasia; Female; Humans; Male; Manometry; Middle Aged; Motion Pictures; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium; Time Factors

The effects of sublingual isosorbide dinitrate (5 mg) and nifedipine (20 mg) were compared in 15 patients with achalasia. The parameters examined included the manometric measurement of the lower esophageal sphincter pressure, the radionuclide assessment of esophageal emptying and the clinical response. The mean basal lower esophageal sphincter pressure fell significantly after both drugs (p less than 0.01), with a maximum fall of 63.5% 10 min after receiving isosorbide dinitrate, but by only 46.7% 30 min after nifedipine. The esophageal radionuclide test meal retention was significantly less (p less than 0.01) only after receiving isosorbide dinitrate. The drug improved initial esophageal emptying by its effect on the lower esophageal sphincter and by relieving the test meal hold-up noted to occur at the junction of the upper and midesophagus. Eight patients cleared their test meal within 10 min after isosorbide dinitrate administration while only two did so after nifedipine. Subjectively, 13 patients had their dysphagia relieved by isosorbide dinitrate and 8 by nifedipine. However, this relief was not confirmed in 4 patients by the radionuclide study and they, as well as the other 3 patients who did not respond to therapy, were referred to pneumatic dilatation. Side effects were more prominent after nitrates. Three of the patients are currently receiving nifedipine and 5 patients received isosorbide dinitrate therapy for 8-14 mo. The radionuclide test meal is currently the best way of objectively evaluating drug therapy in patients with achalasia. Isosorbide dinitrate is more effective than nifedipine in relieving their symptoms.

Topics: Adolescent; Adult; Aged; Esophageal Achalasia; Esophagus; Female; Humans; Isosorbide Dinitrate; Male; Manometry; Middle Aged; Nifedipine; Pyridines; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium