Published on 02/03/2015 by admin
Filed under Internal Medicine
Last modified 02/03/2015
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Case 6
A 69-year-old woman was referred for adenosine stress SPECT MPI for evaluation of dyspnea and chest pressure. She had a history of stent placement in the mid-LAD 3 years previously.
Adenosine was infused at 140 mcg/kg/min over 4 minutes. She was unable to perform low-level treadmill exercise during the infusion. No symptoms were reported during the adenosine infusion, and her blood pressure and ECG responses to adenosine were normal.
The raw planar images demonstrate moderate photon attenuation by the left breast (the bra cup size is 40 D). There is chest-wall adipose tissue present, resulting in further soft-tissue attenuation. The patient’s body mass index is 37 (>30 = obese). In addition, there is marked hepatic and gastrointestinal (GI) tracer activity in close proximity to the heart. GI tracer interference is frequently problematic with pharmacologic stress, particularly when the patient is unable to perform low-level treadmill exercise during the infusion.
SPECT images demonstrate a mild defect in the distal anteroseptal region, with very mild defect reversibility on resting images. The defect could be consistent with breast attenuation artifact, though the mild defect reversibility raises concern for ischemia (possibly in the territory of the prior LAD stent placement). There is also a mild defect in the inferior and inferolateral regions, and subtle defect reversibility is evident on resting images. This stress defect (and the subtle defect reversibility evident on resting images) might be entirely due to GI tracer interference. Ischemia cannot be confidently excluded.
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