Tectnetcium-99m pertechnetate thyroid scan – LEAP collimator

• Opposite lateral and ventral views of the neck and thorax were made. A focal intense area of uptake is observed on the midline of the neck with smooth margins.
• Opposite lateral views of the thorax show a linear area of uptake on the left lateral view that is not observed on the right lateral or ventral views. Normal uptake is observed in the heart and stomach.
• No evidence of ectopic thyroid tissue in the base of the tongue, neck or mediastinum.

Tectnetcium-99m pertechnetate thyroid scan – Pin-hole collimator

• A single ventral views shows the intense area of uptake is located in the left lobe of the thyroid. A faint area of uptake is observed in the right lobe of the thyroid gland.

• Pattern of uptake most consistent with bilateral nodular hyperplasia/multinodular adenomas
• Transient esophageal activity due to swallowing of saliva or gastroesophageal reflux

• Medical treatment – methimazole or I-131 treatment were accepted as this recommendation would vary

• This case was handled well by most candidates with a good overall score.
• Identification of transient esophageal activity due to swallowing of saliva or gastroesophageal reflux was most frequently missed aspect.
• Faint activity of the right lobe indicates abnormality in right lobe as well. Normal thyroid tissue would be completely suppressed and show no uptake.
• Some difficulty correctly identifying the views obtained (right vs left lateral).