Extracardiac Accumulation of Technetium-99m-Pyrophosphate in Transthyretin Cardiac Amyloidosis

Koji Takahashi; Daisuke Sasaki; Tomoki Sakaue; Daijiro Enomoto; Shigeki Uemura; Takafumi Okura; Shuntaro Ikeda; Daichi Yamamoto; Taizo Kono; Nobuhisa Yamamura

doi:10.1016/j.jaccas.2021.02.015

Extracardiac Accumulation of Technetium-99m-Pyrophosphate in Transthyretin Cardiac Amyloidosis

JACC Case Rep. 2021 May 12;3(7):1069-1074. doi: 10.1016/j.jaccas.2021.02.015. eCollection 2021 Jul 7.

Authors

Koji Takahashi^{1

2}, Daisuke Sasaki³, Tomoki Sakaue^{1

2}, Daijiro Enomoto², Shigeki Uemura², Takafumi Okura², Shuntaro Ikeda^{1

2}, Daichi Yamamoto³, Taizo Kono³, Nobuhisa Yamamura⁴

Affiliations

¹ Department of Community Emergency Medicine, Ehime University Graduate School of Medicine, Ehime, Japan.
² Department of Cardiology, Yawatahama City General Hospital, Ehime, Japan.
³ Department of Radiology, Yawatahama City General Hospital, Ehime, Japan.
⁴ Department of Clinical Pathology, Yawatahama City General Hospital, Ehime, Japan.

Abstract

This report presents a rare case of acute decompensated heart failure with technetium-99m-pyrophosphate accumulation in extracardiac sites, such as chest and abdominal walls, in addition to intense myocardial uptake of the tracer. Subsequently, an abdominal fat pad fine-needle aspiration biopsy, which provided positive findings for transthyretin amyloidosis, was performed. (Level of Difficulty: Advanced.).

Keywords: 99mTc, technetium-99m; ADHF, acute decompensated heart failure; ATTR-CM, transthyretin cardiac amyloidosis; CT, computed tomography; DPD, 3,3-diphosphono-1,2-propanedicarboxylic acid; HMDP, hydroxymethylene diphosphonate; LV, left ventricle; MR, mitral regurgitation; PYP, pyrophosphate; SPECT, single photon emission computed tomography; abdominal fat; amyloidosis; bone-avid radiotracer; heart failure; transthyretin.

Publication types

Case Reports