Early postoperative anuria with severe systemic hypertension occurring after a period of initial renal transplant diuresis evokes multiple diagnoses. Hyperacute rejection is rarely seen with rigorous routine pretransplant lymphocytotoxic cross match testing. It is of great importance to detect any nonimmunologic cause of dysfunction that can be remedied, such as delayed tubular necrosis or physical obstruction. The authors present the imaging findings in a case of severe renal impairment caused by a tense peritransplant hematoma. The Page kidney phenomenon is proposed as a curable mechanism of this early allograft dysfunction.
The purpose of this pictorial essay is to illustrate several clinical situations in which SPECT/CT can be effectively applied in nuclear radiology practice.SPECT/CT has recently emerged as a valuable adjunct to standard techniques in clinical nuclear radiology. This technique provides significantly improved scintigraphic localization and characterization of disease, increasingly important in this era of minimally invasive surgery and targeted radiotherapy.
Proximal-type epithelioid sarcoma is an uncommon but aggressive soft-tissue malignancy involving proximal body parts especially perineum and genitalia of adult patients. This entity is a variant form of the conventional epithelioid sarcoma, which is frequently encountered at extremities of adolescents or young adults. The authors present a case of proximal-type epithelioid sarcoma of the scrotum with comprehensive staging and monitoring with PET/CT.
Technetium-99m sestamibi planar and single-photon-emission computed tomographic scintigraphy is useful in the diagnosis of parathyroid gland disease. To understand the various patterns of parathyroid disease, it is important to understand parathyroid embryology and anatomy. The spectrum of parathyroid disease demonstrated with Tc-99m sestamibi scintigraphy includes eutopic disease, ectopic disease, solitary adenoma, double or multiple adenomas, cystic adenoma, lipoadenoma, multiple endocrine neoplasia, hyperfunctioning parathyroid transplant, entities with atypical washout, and nonparathyroid entities that take up Tc-99m sestamibi. The diagnosis of parathyroid tumors with Tc-99m sestamibi scintigraphy is based on the difference in clearance rates between the thyroid and diseased parathyroid glands, and any condition that interferes with radiotracer clearance will limit the effectiveness of the study. The technique is most clearly indicated for the preoperative evaluation of recurrent or persistent hyperparathyroidism, but it is increasingly being used before the initial surgical exploration as well. Subtraction Tc-99m sestamibi and iodine-123 scintigraphy may be helpful in difficult cases. Parathyroid hyperplasia, multisite parathyroid disease, and concomitant thyroid and parathyroid disease remain potential hurdles for this scintigraphic technique, and optimal handling of these problems still relies heavily on the skill and experience of the endocrine surgeon.
Sclerosing mesenteritis is a rare, combined inflammatory and fibrotic process of unknown etiology. Detailed cross-sectional imaging of this entity has been reported with computed tomography. The author presents an additional case of sclerosing mesenteritis demonstrated on fluorine-18 fluorodeoxyglucose positron emission tomography with multidetector computed tomographic correlation.
