Vnitr Lek 2008, 54(9):862-865

⁶⁷Ga-citrate SPECT imaging of the isolated right ventricle heart metastatic malignant melanoma in a patient with chest pain

J. Doležal^1,*, J. Vižďa¹, L. Klzo²

¹ Oddělení nukleární medicíny FN Hradec Králové, přednosta prim. MUDr. Ing. Jaroslav Vižďa

² Radiodiagnostická klinika Lékařské fakulty UK a FN Hradec Králové, přednosta prof. MUDr. Pavel Eliáš, CSc.

Aim:
to present a rare case report about a woman with a right heart ventricle malignant melanoma metastasis who presented with chest pain and that was successfully detected by ⁶⁷Ga-citrate single photon emission computer tomography (SPECT).


Material and method:
a 73-years-old woman with a past history of excision of a malignant melanoma from the right calf, 6 years later, was admitted to hospital with chest pain. The examination excluded myocardial ischemia. The chest CT and MR imaging detected a large tumour mass in the right heart ventricle. The CT and MR finding was evaluated as a suspect benign, mesenchymal intracardiac tumour. The ⁶⁷Ga-citrate scintigraphy for restaging of malignant melanoma was performed. The double-head gamma camera VariCam (Elscint) with infrared body countouring and the large field of view was used. The gamma camera was fitted with medium-energy, parallel-hole collimators. Images were evaluated by processing system Xpert-Pro (Elscint).

Results:
The whole body planar scintigraphy from anterior and posterior view was negative without pathological uptake of ⁶⁷Ga-citrate, but the subsequent chest SPECT revealed oval focus (4 × 5 × 4 cm) of the pathological uptake in the right heart ventricle. The SPECT slices and whole body planar scans were evaluated as the suspect isolated metastasis of a malignant melanoma in the right ventricle (it was proven by biopsy) without others metastases. The woman underwent percutaneous transcatheter biopsy from the right heart ventricle and malignant melanoma metastasis was proven.

Conclusion:
the chest SPECT improved the sensitivity of ⁶⁷Ga-citrate scintigraphy. The suspect malignant character of cardiac involvement was proven by ⁶⁷Ga-citrate scintigraphy.

Keywords: metastatic malignant melanoma; right heart ventricle; ⁶⁷Ga-citrate scintigraphy; SPECT

Received: January 14, 2008; Accepted: April 17, 2008; Published: September 1, 2008  Show citation