Journal of Cancer Research and Therapeutics Medknow Publications on behalf of the Association of Radiation Oncologists of India (AROI) ISSN: 0973-1482 EISSN: 1998-4138 Vol. 7, Num. 1, 2011, pp. 97-98

Journal of Cancer Research and Therapeutics, Vol. 7, No. 1, January-March, 2011, pp. 97-98

Letter to the Editor

Displaced left kidney masquerading as splenic blush in ^99m Tc-DTPA GFR study in a patient of paravertebral primitive neuroectodermal tumor

Sandip Basu, Surendra H Moghe

Radiation Medicine Centre (BARC), Tata Memorial Hospital Annexe, Parel, Mumbai-400 012, India

Correspondence Address: Sandip Basu, Radiation Medicine Centre (BARC), Tata Memorial Hospital Annexe, Parel, Mumbai-400 012, India, drsanb@yahoo.com

Code Number: cr11024

PMID: 21546756

DOI: 10.4103/0973-1482.80454

Sir,

Careful correlation with ancillary investigations is an important part of interpretation of a functional study and should be carried out specifically when an unusual situation is encountered. We herein report a patient of paravertebral primitive neuroectodermal tumors (PNET), who was referred for pre-chemotherapy glomerular filtration rate (GFR) study for evaluation of GFR by the scintigraphic method. He was paraplegic with bladder and bowel incontinence. The 6-minute GFR study [Figure - 1]a and b carried out after injection of ^99m Tc-Diethylene triamine pentaacetic acid (DTPA) apparently demonstrated no flow in the left renal bed region and hence was initially thought to be due to absence of left kidney. Subsequent skeletal scintigraphy [Figure - 2] for metastatic work up showed an unusually located and more horizontally disposed left kidney much above its normal location. There was evidence of photopenia around the level of D11-L1 vertebrae corresponding to the large primary tumor that was clinically palpable in the posterior abdominal wall. This finding was subsequently reiterated by the ^99m Tc-Dimercaptosuccinic acid (DMSA) renal scan [Figure - 3], which reiterated the impression of a displaced left kidney that was, in all likelihood, due to the large abdominal primary.

The abnormality in the genitourinary system (congenital and acquired due to extraneous causes) can lead to varying and confounding findings in the radionuclide renal studies as well as skeletal scintigraphy. ^[1],[2] Unrelated pathology in a different organ can also lead to such a finding ^[3],[4] as was evidenced in the present case. Careful history and correlation is required to obviate diagnostic errors in such situation. The present case is reported to highlight the importance of this and is presented here as an interesting case vignette.

References

Copyright 2011 - Journal of Cancer Research and Therapeutics

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