Diagnoses
Cardiac
1. Coronary Artery Disease
The Persantine study shows a moderate to severe inferior wall perfusion
defect with stress (arrowheads) with partial reversibility on the resting
images (small arrowheads).
Cardiac catheterization showed severe coronary artery disease.
There was a 50% left main coronary artery stenosis; there was a 70% LAD
stenosis; the circumflex coronary artery was diffusely diseased, 60-70%;
and the right coronary artery was diffusely diseased with occlusion in
the mid portion.
2. Cardiomyopathy
There is a dilated left ventricle on stress imaging which is less dilated
on rest imaging. Gated images show marked globally reduced ventricular
function. The left ventricular ejection fraction was calculated to
be 23%.
Echocardiography also showed severe left ventricular dysfunction.
Pulmonary
3. Non-small cell lung cancer (NSCLC)
On the raw data images from the myocardial perfusion study there is increased
uptake at the left lung apex, seen best on the sestamibi stress data.
Persantine Myocardial Perfusion Scan
| Rest Raw Data |
Stress Raw Data |
 |
 |
The raw sestamibi data was reconstruction over the lung fields and is
displayed in axial, sagital, and coronal views. The SPECT data was
reprojected.
SPECT Reconstruction of Left Chest
from Myocardial Perfusion Scan Data
| Axial |
Sagital |
 |
 |
| Coronal |
Reprojection |
 |
 |
There is a sestamibi avid lesion in the left upper lobe. There
was a known left upper lobe nodule on chest X-ray. On chest CT the
nodule was spiculated. Needle biopsy showed non-small cell lung cancer.
4. Hypertrophic Osteoarthropathy
Bone scan show mild patchy increased uptake in the lower extremities particularly
in the tibias, likely mild hypertrophic osteoarthropathy related to the
non-small cell lung cancer.
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J. Anthony Parker, MD PhD, Tony_Parker@bidmc.harvard.edu