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Mediastinal Duplication Cyst on 99mTc Pertechnetate Scan.

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A 3-year-old boy with abdominal pain and anemia was diagnosed with ectopic gastric mucosa in his chest. A Tc-pertechnetate scan identified the abnormal tissue, confirmed by CT scans.

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Area of Science:

  • Pediatric Gastroenterology
  • Nuclear Medicine Imaging
  • Thoracic Surgery

Background:

  • Ectopic gastric mucosa is a rare congenital anomaly.
  • Symptoms can be non-specific, leading to diagnostic challenges in children.
  • Tc-99m pertechnetate scintigraphy is a key diagnostic tool for ectopic gastric mucosa.

Observation:

  • A 3-year-old boy presented with chronic abdominal pain, melena, and anemia.
  • Initial upper endoscopy was unremarkable.
  • Tc-99m pertechnetate scan showed abnormal tracer uptake in the thoracic region.

Findings:

  • The abnormal uptake on scintigraphy was persistent in delayed imaging, suggestive of ectopic gastric mucosa.
  • Chest ultrasound and contrast-enhanced CT (CECT) revealed a large, multiseptate cystic lesion in the retrocardiac region.
  • The lesion's location correlated with the area of increased tracer accumulation.

Implications:

  • This case highlights the utility of Tc-99m pertechnetate scintigraphy in diagnosing ectopic gastric mucosa presenting outside the gastrointestinal tract.
  • Multimodality imaging, including CECT, is crucial for characterizing the lesion and guiding surgical management.
  • Early diagnosis and intervention are essential for managing complications associated with ectopic gastric mucosa.