Research ArticleIMAGING

False-Positive Pericardial Effusion Due to Breast Attenuation on Equilibrium Radionuclide Angiocardiography

Martha V. Mar and E. Edmund Kim
Journal of Nuclear Medicine Technology June 2011, 39 (2) 105-110; DOI: https://doi.org/10.2967/jnmt.110.083014

Article Figures & Data

Figures

  • FIGURE 1.
    FIGURE 1.

    Breast position with breast implants seen on axial CT image (B) creates photopenic area above and to left of left ventricle in LAO view, indicated by arrow (A). Large breast that drapes to side of chest wall as seen on frontal radiograph (D) does not create photopenic area in LAO view (C).

  • FIGURE 2.
    FIGURE 2.

    Frontal radiographs acquired with arms up show how far breast sags below heart silhouette (arrows, C and F). Anterior ERNA projections acquired with arms down demonstrate how far breast attenuation shadow sags below heart (arrows, B and E). Photopenic area below heart is larger in second case (D) than in first case (A).

  • FIGURE 3.
    FIGURE 3.

    Slight difference in oblique tilt alters photopenic area seen in LAO view of ERNA performed 1 y apart (A and B). Frontal radiograph displays breast size, position, and sag (C).

  • FIGURE 4.
    FIGURE 4.

    Collateral vessel seen on left breast of both anterior ERNA scans (B and D) served as reference landmark to evaluate effect of halo appearance when slightly changing oblique tilt position of LAO images scanned 7 wk apart (A and C). Frontal radiograph shows breast size, position, and sag (E).

  • FIGURE 5.
    FIGURE 5.

    First case demonstrates obvious breast attenuation shadow in anterior image (B), therefore confirming LAO U-halo to be artifact due to breast attenuation (A). Second case is suggestive of true pericardial effusion due to photopenic U-halo in LAO view (D) and appearance of halo in anterior image that is not obvious breast attenuation shadow (E). Second case proved to be false-positive pericardial effusion due to breast attenuation. Frontal radiographs demonstrate breast size, position, and sag (C and F).

  • FIGURE 6.
    FIGURE 6.

    Three cases demonstrate photopenic U-halo appearance on ERNA images with small (A–C), moderate (E–G), and large (I–K) true-positive pericardial effusion. Axial CT images were acquired within 0–9 d of ERNA scan (D, H, and L).

  • FIGURE 7.
    FIGURE 7.

    Axial CT image reveals epicardial fat pad (arrow on D) that mimics photopenic U-halo appearance of pericardial effusion on ERNA images (A–C).

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