Enterogastroesophageal reflux detected on 99m-technetium sestamibi cardiac imaging as a cause of chest pain
A 71-year-old woman with complaints of precordial pain for 2 years was referred to our department for the evaluation of ischemic heart disease. The patient had a history of weight loss, decreased appetite, fatigue, chronic hepatitis C, and cholecystectomy. The patient underwent dipyridamole pharmacological stress test using a 4-min infusion of 0.142 mg/kg/min dipyridamole and subsequently 370 MBq (10 mCi) Tc-99m MIBI was injected intravenously. After 60 minutes, radiotracer injection, stress single photon emission tomography (SPET) imaging with a dual head gamma-camera (GE, Infinia), which was fitted with a low-energy, high resolution, parallel-hole collimator, was performed. Stress MPI showed normal perfusion findings []. SPET images (short-axis, horizontal, and vertical) were reconstructed using a low-pass filter, using no attenuation correction. The images were also evaluated using three-dimensional localization with the standard tomographic sections of the body (sagittal, coronal and transaxial) and then displayed in static slices for further assessment. On the raw projection images, cineloop views and reconstructed slices, radiotracer concentration was seen in the stomach secondary to enterogastric reflux and retrocardiac intense linear activity was seen throughout the esophagus in the midline of the thorax, retromedial to the cardiac activity secondary to gastroesophageal reflux (GER) []. In addition, hepatic clearance was considered very rapid because of there was a little hepatic accumulation during the study.\nAfter stress MPI, immediately, a Tc-99m MIBI whole-body scan performed, no pathologic accumulation of the radiotracer was detected and there was no tracer retention in the esophagus and stomach [].\nFollowing exclusion of a cardiac cause of chest pain, the patient underwent a scintigraphic evaluation for GER and GER observed on the acquired dynamic images. GER was interpreted by three methods: Visual interpretation, time activity curve and condensed image. According to the number of episodes (grade 0: No reflux, grade 1: 1-3 episodes, grade 2: ≥4 episodes) the scintigraphic findings were interpreted as grade 1, according to the location (distal, middle or proximal esophagus) GER was reached proximal 1/3 of the esophagus, and according to intensity (low, moderate or high) interpreted as high [Figure –]. Dynamic images were acquired for 16 min. The patient requested the acquisition be stopped due to patient's discomfort at 16th min and no delayed images of thorax provided. Upper gastrointestinal endoscopic examination of the patient revealed minimal inflammation in the distal part of the esophagus and hyperplastic polyp in the gastric antrum and confirmed pathologically [Figure and ], and there was no evidence of esophageal neoplastic pathology. Antireflux medication (lansoprazole) started by gastroenterologist and symptoms of the patient were improved.