CASE 147 A 65-year-old man presents with melena and acute gastrointestinal bleeding. Fig. 147.1 • The in vitro or modified in vivo methodology is used to label autologous red blood cells with 25 mCi of 99mTc-pertechnetate. • The patient is placed in a supine position beneath a gamma camera with a large field of view. • Initial flow images are acquired at 1 to 3 seconds per frame for 1 minute (not shown). • Dynamic images are acquired at 1 minute per frame for 89 minutes. Fig. 147.2 Serial anterior images of the abdomen (Fig. 147.1) demonstrate progressively increasing focal activity in the right lower quadrant. On continued imaging (Fig. 147.2), the activity can be seen to be transiting to the transverse colon. • Gastrointestinal bleeding in the region of the cecum • Atypical site of bleeding in the small bowel
Clinical Presentation
Technique
Image Interpretation
Differential Diagnosis
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