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Year : 2018  |  Volume : 17  |  Issue : 3  |  Page : 198-200

Massive pericardial effusion: A rare and easily missed finding in myocardial perfusion scintigraphy

Nuclear Medicine Unit, Queen Elizabeth Hospital, Kowloon, Hong Kong, China

Correspondence Address:
Kwan Kit Wu
Nuclear Medicine Unit, Queen Elizabeth Hospital, Kowloon, Hong Kong
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DOI: 10.4103/wjnm.WJNM_39_17

PMID: 30034286

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A 72-year-old gentleman underwent myocardial perfusion scintigraphy (MPS) for sinus tachycardia of unknown cause. Baseline electrocardiography (ECG) showed sinus tachycardia and electrical alternans. Thallium-201 stress-redistribution MPS was performed with dipyridamole stress. On the raw projection images, a photopenic “halo” was noted surrounding the heart. Reconstructed slices showed small left ventricle with no obvious perfusion defect. Review of single-photon emission computed tomography/computed tomography images showed suspected large pericardial effusion. The patient was admitted and Echocardiography showed significant circumferential pericardial effusion with early tamponade effect. Subsequent bedside pericardiocentesis aspirated 800 ml blood-stained fluid and the cytology yielded metastatic adenocarcinoma with features suggestive of pulmonary primary. Pericardial effusion is a rare finding in MPS. Finding of a “halo” around the heart should raise suspicion on the presence of pericardial effusion and confirmatory investigation such as ECG may be warranted.

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