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Thallium-201 accumulation by epidermoid inclusion cyst
1Radiology Service, Veterans Affairs Medical Center, Dallas, Texas.
Summary
An unusual finding of thallium-201 (201Tl) accumulation in a skin cyst during cardiac imaging highlights the importance of careful examination. This case demonstrates how benign skin lesions can mimic metastatic disease on nuclear scans.
Area of Science:
- Nuclear Medicine
- Cardiology
- Radiology
Background:
- Myocardial perfusion scans using thallium-201 (201Tl) are crucial for evaluating coronary artery disease.
- Accurate interpretation requires differentiating cardiac from extra-cardiac tracer uptake.
Observation:
- An elderly male showed unexpected 201Tl accumulation outside the heart during a myocardial perfusion scan.
- A concurrent computerized axial tomographic (CAT) scan identified a subcutaneous lesion on the left posterior thorax.
Findings:
- Surgical excision confirmed the lesion as an epidermoid inclusion cyst.
- A follow-up nuclear scan showed no residual extra-cardiac tracer localization.
Implications:
- Benign skin lesions like epidermoid cysts can be mistakenly identified as metastatic deposits on 201Tl scans.
- Thorough examination of the integument is essential to prevent misdiagnosis in neoplastic evaluations.