December 2007 Vol 8 After Meeting.indd


A 58 YEAR OLD MALE PATIENT WAS  admitted with a two month history of short-ness of breath and left hypochondral pain.  The plain radiograph of the chest [Figure 1] showedlarge left pleural effusion. Computed tomography (CT)of the chest [Figure 2] confirmed the presence of a large
left pleural effusion. In addition, it showed circumfer-
ential nodular masses involving the left parietal pleura. 
The gallium scan showed diffuse circumferential up-
take in the left thoracic cavity. Fused CT/Ga-67 SPECT 
image, using Syngo fusion software (Siemens Medical 
Solutions), allowed the precise localization of the gal-
lium uptake to the left pleura [Figure 2]. The patient
underwent pleural biopsy, which showed a diffuse large
B cell lymphoma.

Most of the tumours involving the pleura invade 
the pleura secondarily. The usual primary tumours
are bronchogenic carcinoma, breast cancer, lympho-
ma, and ovarian or gastric tumours.1 Primary benign 
and malignant tumours of the pleura are uncommon. 
Primary malignant pleural neoplasms can present as 
solitary nodular mass or diffuse infiltrating tumour.2 

Fused CT/Ga-67 SPECT Images for Detection of 
Pleural Lymphoma

*Khalid Alsaadi,1 *Humoud Al-Dhuhli,1 Samir Hussain,1 Ikram Burney2

SULTAN QABOOS UNIVERSITY MEDICAL JOURNAL 
DECEMBER 2007 VOL 7, NO. 3, P. 261-262
SULTAN QABOOS UNIVERSITY©
SUBMITTED - 3RD JUNE 2007
ACCEPTED - 1ST SEPTEMBER 2007

I N T E R E S T I N G  M E D I C A L  I M A G E

اجلَنَب اللمفاويه اورام CT/Ga67 SPECT لكشف صور دمج

برني اكرام حسني، ، سامر الذهلي حمود ، خالد السعدي

1Department of Radiology and Microbiology, Sultan Qaboos University Hospital, P. O. Box 38, Al-Khod 123, Muscat, Sultanate of Oman; 2Department 
of Medicine, Sultan Qaboos University Hospital, P. O. Box 38, Al-Khod 123, Muscat, Sultanate of Oman

*To whom correspondence should be addressed. Email: alzuhli@hotmail.com

Figure 1: Fused CT/Ga-67 SPECT Image. Enhanced axial CT image at level of the lower thorax shows 
circumferential nodular pleural thickening. Note pleural effusion.  The Ga-67 SPECT image of the 
chest shows circumferential high uptake along the left pleural cavity. The fused CT/ Ga-67 SPECT 
image clearly demonstrates the high uptake in the pleural masses shown on the CT

Figure 1: Frontal chest radiograph shows almost 
complete opacification of the left hemithorax with 
shift of the mediastinum to the right



A L S A A D I  K H A L I D ,  A L - D H U H L I  H U M O U D ,  S A M I R  H U S S A I N  A N D  I K R A M  B U R N E Y

262

Primary pleural lymphoma is rare. It occurs in both 
Hodgkin’s and non Hodgkin’s disease. The lymphoma-
tous deposits arise from lymphatic channels and lym-
phoid aggregates in the subpleural connective tissue 
below the visceral pleura. Associated pleural effusion is
attributed to obstruction of lymphatic channels by me-
diastinal lymphadenopathy.3 Although primary pleural 
lymphoma as the only initial site of malignancy is rare, 
lymphomatous involvement of the pleura not uncom-
monly occurs secondarily. In this circumstance, it ap-
pears associated with mediastinal lymphadenopathy or 
pulmonary parenchymal lymphoma or develops as a 
manifestation of recurrent disease.4

The standard non-invasive radiological examina-
tions include plain radiograph and computed tomog-
raphy. CT scans help in deciding the location and the 
extent of the tumour. Gallium scans play a complemen-
tary role in diagnosis and staging. 

CT/67Ga SPECT fusion imaging allowed precise lo-
calization of gallium uptake and correct attribution to 
the viscera involved, thereby altering the diagnosis in 

20%-25% of studies in comparison with CT and 67Ga 
SPECT analyses alone. CT/67Ga SPECT fusion there-
fore appears valuable in facilitating the interpretation 
of 67Ga scintigraphy and it is recommend for use in pa-
tients with lymphoma when CT and 67Ga scintigraphy 
are planned.5

R E F E R E N C E S

1. Bonomo L, Feragalli B, Sacco R, Merlino B.  Storto ML. 
Malignant pleural disease. Eur Radiol 2000; 34;98-118.

2. Shuman LS, Libshitz HI. Solid pleural manifestations of 
lymphoma. Am J Roentgenol 1984; 142:269-273.

3. Malatskey AM, Fields S, Lisbon E. CT appearance of pri-
mary pleural lymphoma. Compute Med Imaging Graph 
1989; 13:165-167.

4. Dynes MC, White EM, Fry WA, Ghahremani GG. Im-
aging manifestation of pleural tumours. Radiographics 
1992; 12:1191-1201.

5. Bernstine H, Bar-Sever Z, Ekstein J, Hardoff R. Ga-67
scintigraphy in a rare case of primary Hodgkin’s lympho-
ma. Clin Nucl Med 1999; 24:880-881.