HIATAL-HERNIA ON WHOLE-BODY RADIOIODINE SURVEY MIMICKING METASTATIC THYROID-CANCER

Total body I-131 scanning done on a 67-year-old woman with thyroid can cer revealed abnormal tracer uptake within the mid-thorax, thought to represent metastasis in the mediastinum or thoracic spine. Single-phot on emission computed tomography images of the thorax showed contiguity between the thoracic uptake and the normal, physiologic uptake of rad ioiodine in the stomach, suggesting physiologic accumulation within a hiatal hernia. To confirm the alimentary tract location of the radioio dine, a study using orally administered Tc-99m SC in water was perform ed. The images were similar to the iodine images and revealed a patter n consistent with hiatal hernia. A hiatal hernia was also observed as an incidental finding on chest radiographs and an MRI. This case illus trates the potential for an abnormal anatomic configuration to mimic m etastatic thyroid cancer and shows how SPECT and oral Tc-99m SC images may be useful in making this distinction.