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Case Reports
. 2024 Sep-Oct;39(5):406-408.
doi: 10.4103/ijnm.ijnm_87_24. Epub 2025 Jan 25.

Atypical Appearance on Radioiodine Scintigraphy Due to Achalasia Cardia - A Potential Diagnostic Pitfall

Kunal Ramesh Chandekar  1 , Nishikant Avinash Damle  1 , Chandrasekhar Bal  1
Affiliations
Case Reports

Atypical Appearance on Radioiodine Scintigraphy Due to Achalasia Cardia - A Potential Diagnostic Pitfall

Kunal Ramesh Chandekar et al. Indian J Nucl Med. 2024 Sep-Oct.

Abstract

We present the case of a 36-year-old woman with papillary thyroid cancer (PTC) who had undergone thyroidectomy and nodal dissection. In addition to thyroid remnant and nodal metastases, initial postoperative radioiodine (RAI) diagnostic whole-body scintigraphy showed abnormal diffusely increased linear band-like uptake in the thorax corresponding to the esophageal contour, raising suspicion of lower esophageal obstruction. Retrospective inquiry revealed a history of long-standing, progressive dysphagia. Findings of computed tomography, barium swallow study, and esophageal manometry were consistent with achalasia cardia. She underwent high-dose RAI therapy for PTC and laparoscopic cardio-myotomy for achalasia cardia. This case report aims to familiarize nuclear medicine physicians with the appearance of achalasia cardia on RAI scintigraphy, which may mask surrounding lymph nodal or vertebral metastases. Such a finding when encountered should also prompt further work-up and appropriate management.

Keywords: Achalasia cardia; atypical; esophagus; papillary thyroid cancer; radioiodine; scintigraphy.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
A 36-year-old lady with papillary thyroid cancer underwent thyroidectomy and nodal dissection surgery. Planar images (a) anterior whole-body, (b) posterior whole-body, (c) anterior regional of the initial postoperative iodine-131 diagnostic whole-body scintigraphy (DxWBS) demonstrated three foci of intense tracer uptake in the neck and upper thorax suggestive of thyroid remnant and lymph nodal metastases (black arrows). Diffusely increased, tubular tracer uptake was also noted in the thoracic region consistent with esophageal contour (red arrows). Corresponding noncontrast computed tomography images (d) coronal, (e and f) transaxial revealed a diffusely dilated esophagus with air-fluid level (red arrows) and few rounded, paratracheal and pre-tracheal lymph nodes (yellow arrows). Follow-up DxWBS (g) anterior, (h) posterior planar images performed 6 months after high-dose radioiodine therapy and laparoscopic cardiomyotomy surgery (for achalasia cardia) showed no abnormal radiotracer uptake
See this image and copyright information in PMC

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