Epiphrenic diverticulum: potential pitfall in thyroid cancer iodine-131 scintigraphy

Area of Science:

• Nuclear medicine
• Oncology
• Gastroenterology

Background:

• Thyroid cancer scintigraphy using iodine-131 is vital for detecting residual or recurrent disease.
• Unusual patterns of iodine-131 uptake can lead to false-positive diagnoses.
• Differentiating true malignancy from physiological or artifactual uptake is clinically significant.

Observation:

• A patient presented with iodine-131 uptake in the mediastinum during thyroid cancer follow-up.
• This uptake was not associated with thyroid tissue but with an esophageal epiphrenic diverticulum.
• Radiographic and cross-sectional imaging were used for correlation.

Findings:

• The mediastinal iodine-131 uptake was attributed to an epiphrenic diverticulum of the esophagus.
• This represents a case of physiological or artifactual tracer accumulation mimicking malignancy.
• Correlation with other imaging modalities is key to accurate interpretation.

Implications:

• False-positive results in iodine-131 scintigraphy can lead to unnecessary treatments and patient anxiety.
• Esophageal epiphrenic diverticula should be considered in the differential diagnosis of unexpected mediastinal iodine-131 uptake.
• Integrating radiographic or cross-sectional imaging improves diagnostic accuracy in thyroid cancer follow-up.