123I accumulation in thoracic neoesophagus masking residual papillary thyroid cancer

A 56-year-old woman with prior esophageal resection and reconstruction after accidental lye ingestion presented for management of recently diagnosed thyroid cancer. She had total thyroidectomy with pathology demonstrating bilateral well-differentiated papillary thyroid cancer measuring up to 1.0 cm and positive margins. Approximately 1 month after surgery, I whole-body scan was obtained. Planar images demonstrated linear I uptake in the thorax, compatible with accumulation in the neoesophagus. Given the patient's postsurgical anatomy, SPECT/CT of the thorax was done and demonstrated additional focal I uptake in the left lower neck, compatible with residual thyroid tissue versus thyroid cancer (lymph node metastasis).