Findings: Following the intravenous administration of 11 mCi of technetium 99m labeled Ultratag red blood cells, multiple images were obtained in the anterior projection over the abdomen. A single image from this study is submitted.

Linear area of increased radiopharmaceutical activity is seen within the mid abdomen which increases intensity over time and conforms to the contour of the bowel. In addition, it moves bidirectionally.

Diagnosis: Upper gastrointestinal hemorrhage.

Discussion: Evaluation for a GI bleed can be performed both with technetium 99m labeled red blood cells or with technetium 99m sulfur colloid. These studies are primarily for evaluation of lower GI bleeds, because increased background activity limits evaluation of the upper GI tract.

A positive scan must demonstrate three findings. These are as follows: 1) focal activity which increases over time. 2) a shape which conforms to bowel and 3) it must progress distally and show movement.

These studies are much more sensitive than angiograms. Bleeding rates as low as .2 ml per minute can be detected. However, false positive scans from free pertechnetate can occur. If this is a concern, imaging of the neck to confirm optimal tag can be performed.

Upper endoscopy performed on this patient revealed a gastric ulcer.

References:
Mettler FA, Jr., Guiberteau MJ. Essentials of Nuclear Medicine Imaging, 4th Edition.
W. B. Saunders, Philadelphia. 1998:256-258.

Return to Nuclear and SPECT Imaging Page