5.1 - CORRELATION BETWEEN GALLIUM-67 PULMONARY SCINTIGRAPHY AND HIGH RESOLUTION COMPUTED TOMOGRAPHY OF THE THORAX IN PARACOCCIDIODOMYCOSIS (SOUTH AMERICAN BLASTOMYCOSIS).

Santos AO, Takahara JS, Quagliato Jr. R, Zanardi V, Menezes JR, Pereira JA, Lima MCL, Etchebehere ECSC, Ramos CD, Camargo EE. Division of Nuclear Medicine, Department of Radiology and Department of Pneumology, Campinas State University (UNICAMP), Campinas, Brazil.

South American blastomycosis is the most common systemic fungal infection in Latin America and affects the lungs in 80 % of the patients (pts). Imaging is very important to diagnose the disease and for monitoring response to treatment. To compare the performances of high resolution computerized tomography of the thorax (HRCT) and gallium-67 scintigraphy (GS), 13 pts (12 male and 1 female, 30-54 years) with South American blastomycosis were studied. All pts had at most 6 months of treatment. Nodules, condensations and cavitations on the HRCT were considered as signs of the parenchymal form of the disease and GS, in these pts, showed increased gallium-67 accumulation. Stripes and interstitial thickening on HRCT which are present in the progressive form of the disease, showed mild gallium-67 accumulation. There was an agreement of findings in 10 of 13 pts (77%). Two pts with nodules, cavitations, stripes and conglomerate areas in the HRCT had normal GS (no inflammation). In one of the pts, HRCT revealed only lobar emphysema while GS demonstrated mild diffuse lung accumulation. The association of both methods (anatomical findings and the degree of inflammation/infection) is useful for studying the extent and activity of the disease.

Caligaris F , Érico L. Camacho, Adriana I. Joaquim , Roberto A.de Toledo, Elisete Funes, Fernanda R. Q. Santos, Eleuses V. Paiva - Serviço de Medicina Nuclear e de Reumatologia do Hospital de Base -FUNFARME– São José do Rio Preto

The importance of the bone scintigraphy to detect osteoarticular lesions related to brucellosis will be discussed in a case report. A patient with the diagnosis of brucellosis seeks medical attention for low back pain. Radiographs of the lombar and sacral region revealed degenerative changes and a CT scan showed spondiloarthrosis at T12-L1, sclerosis and nonspecific irregularities in L1 and L2. Bone scintigraphy using MDP-99mTc demonstrated significant increased uptake in thoracic and lombar vertebras, sacroiliac joints and femur. The diagnosis of bone brucellosis is frequently underestimated. The literature describes that up to 40% of patients have bone involvement at presentation, preferably localized in the sacroiliac joints but rarelly involving long bones. The most sensitive test to evaluate bone involvement of brucellosis is bone scintigraphy and even tissue biopsy maybe negative in more than 50% of cases.

Fábio M. Silva, Adriana I. Joaquim, Márcio C. Pereira, Eleuses V. Paiva - Serviço de Medicina Nuclear e de Otorrinolaringologia da Sociedade Portuguesa de Beneficência – São José do Rio Preto, SP

We report a case of a patient with malignant otitis externa on the left side in which the 3 phase bone scan using MDP-Tc99m was used to confirm the clinical diagnosis and the extent of the complication. The bone scan showed absent blood flow in the left transverse and sigmoid venous sinuses, increased capillary permeability to the left temporal region and severelly increased bone uptake to the left mastoid region. This case demonstrates that the scintigraphic study can be useful to evaluate 2 of the main complications of malignant otitis externa, which are thrombosis of the transverse and sigmoid venous sinuses and mastoiditis.

Érico L. Camacho, Fábio M. Silva, Mário L. M. Lins Filho, Eleuses V. Paiva - Serviço de Medicina Nuclear do Hospital de Base- FUNFARME ,São José do Rio Preto, SP.

We report a case of a child, 2 years and 10 months old, with initial diagnosis of pneumonia and dehydration. The patient was managed initially with intravenous fluids and antibiotics with initial improvement One week later there was recurrence of fever and a rapid deterioration of the cardiorespiratory system requiring transfer to the peadiatric intensive care unit. An echocardiogram was performed, revealing a dilated cardiomyopathy, severe difuse hipokinesia, right pleural effusion, low cardiac output and pulmonary hypertension. A gallium study was performed to evaluate inflammatory activity in the myocardium. The images revealed significantly increased uptake in the myocardium, confirming the clinical hypothesis of acute myocarditis as well as abnormal uptake in the upper left hemithorax (region of the subclavian), corresponding to an unexpected infection at the catheter tip.

Teixeira ABMJ, Etchebehere ECSC, Santos AO, Lima MCL, Ramos CD, Camargo EE. Division of Nuclear Medicine, Department of Radiology, Campinas State University (UNICAMP), Campinas, Brazil.