Umbilical Varices: A Potential Pitfall in Gastrointestinal Bleed Scintigraphy Interpretation

Abstract

Tc-99m labeled red blood cell (RBC) scintigraphy is commonly used in the evaluation of acute gastrointestinal (GI) bleeding. On Tc-99m RBC studies, GI bleeding is seen as an initial focus of increased radiotracer activity that on subsequent images increases in intensity and changes position in a pattern that confirms to segments of bowel. We report a case of a patient with multiple episodes of GI bleeding referred to detect the source of bleeding. A Tc-99m labeled RBC scan was performed and the findings showed a focal abnormal hot spot in the mid quadrant of the abdomen, seen promptly in initial dynamic images. Subsequent static and single-photon emission computed tomography-CT (SPECT-CT) images found it to be umbilical varices. Most varices fill promptly as in this case and should not be misinterpreted as a focus of hemorrhage. SPECT-CT should be used in such cases so that that false-positive interpretation can be avoided.

Keywords: False-positive; gastrointestinal bleed scintigraphy; single-photon emission computed tomography-computed tomography; umbilical varices.

Figure 1

Anterior 60 min dynamic images show no focal abnormal increased tracer uptake in any quadrant of abdominal cavity suggestive of any active gastrointestinal bleed. Focal tracer uptake is noted in mid quadrant of abdomen in the region of umbilicus in initial dynamic images (arrow in initial two frames); persisting throughout dynamic phase without any significant change in intensity or direction throughout dynamic phase (arrow in last two frames)

Figure 2

(a-f) Serial static anterior images show no significant change in intensity or direction of tracer uptake in mid quadrant of abdomen in the region of umbilicus (see arrows in serial static images)

Figure 3

Single-photon emission computed tomography images were taken at 1.5 h postinjection. Coronal images show linear area of abnormal tracer uptake extending from the level of liver to the level of umbilicus in anterior most sections (see arrows in last two frames of 1^st raw)

Figure 4

(a-d) Single-photon emission computed tomography-computed tomography images confirm that linear area of increased tracer uptake seen in single-photon emission computed tomography images extending from liver to umbilicus actually correlate with the umbilical varices (see arrows)