Discrepant sulfur colloid and radioparticle liver uptake in superior vena cava obstruction: case report

The presence of collateral venous channels connecting the upper extremity veins and portal vein via the paraumbilical veins is considered the probable explanation for the observed scintigraphic hepatic "hot spot". This is seen in [99mTc]sulfur colloid liver imaging and perfusion lung imaging with 99mTc radiolabeled particles injected into an antecubital vein in the presence of superior vena caval (SVC) obstruction. The typical distribution is one of focal uptake centrally, anteriorly, and inferiorly. An unusual pattern is described in this report and mechanisms proposed for the "diffuse homogeneous" hepatic uptake also observed in a patient with SVC obstruction undergoing a perfusion lung scan.