Hiatal hernia detected by SPECT/CT on a lung ventilation perfusion scintigraphy

Summary

Aim: To present a case of 78-y-old lady with a hiatal hernia detected during lung scintigraphy with emphasis of using SPECT/CT for imaging and aerosol for ventilation.

Case report: 78-y-old polymorbid female patient was sent to our department because of polyvalent allergy to exclude pulmonary embolism. She suffered from a persistent irritating cough with a small hemoptysis. We performed a ventilation and a perfusion lung scan. Both perfusion and ventilation of both lungs were homogenous. Hiatal hernia was detected as an incidental finding thanks to hybrid imaging and a use of aerosol for the ventilation scan. She was sent to our department once more due to a suspicion of a deep venous thrombosis with an edema of right lower extremity in April 2019. There were a repetitive oppressive and a fiery chest pain propagating to the neck, without dyspnea, sometimes with a nausea and a vomiting. Scintigraphy of a lung perfusion demonstrated a homogenous perfusion of both lungs, ventilation scintigraphy was not indicated. Hiatal hernia was still detected on a low dose CT, however, it can be easily overlooked due to an absence of a ventilation scan.

Conclusion: Our case report brings attention to a possibility to detect a hiatal hernia as an alternative diagnosis during lung scanning. It was made possible thanks to a hybrid imaging and a use of an aerosol for a ventilation scan. At this case, it can explain patient symptoms which were not explained by other performed procedures.

Keywords:

aerosol – hiatal hernia – chest pain – lung scintigraphy – SPECT/CT