Tc-99m red blood cell imaging in a patient with blue rubber bleb nevus syndrome

Blue rubber bleb nevus syndrome, first discovered in 1860 by Gascoyen, is a rare syndrome characterized by multiple venous malformations (hemangiomas) of the skin and in the gastrointestinal tract. These hemangiomas may be found in the skin, GI tract, central nervous system, thyroid, parotid, eyes, oral cavity, musculoskeletal system, lungs, kidneys, liver, spleen, and bladder, and carry a significant potential for serious bleeding. We report a case of a 9-year-old patient who presented with bloody stools and was referred for localization of the bleeding site. A Tc-99m labeled red blood cell (RBC) scan showed no evidence of active lower GI bleeding but demonstrated multiple venous malformations throughout the body. Tc-99m labeled red blood cell imaging may be helpful to delineate the extent of involvement in patients with blue rubber bleb nevus syndrome.