Case Report 59 Vol. 18, No. 1, 2004 Annals of Nuclear Medicine Vol. 18, No. 1, 59–62, 2004 CASE REPORT Received May 26, 2003, revision accepted October 27, 2003. For reprint contact: Sami Boughattas, M.D., Associate Pro- fessor, Department of Nuclear Medicine, Sahloul’s Hospital, 4054, Sousse, TUNISIA. E-mail: BOUGHATTASSAMI@netscape.net INTRODUCTION THE SCINTIGRAPHIC DETECTION of well-differentiated thy- roid cancer metastases prior to thyroidectomy is uncom- mon because the very low iodine uptake on tumoral tissue comparatively to the normal thyroid tissue. There are only a few reports of Tc-99m pertechnetate and/or radioiodine accumulation in metastases in the presence of intact thyroid tissue. 1–5 Here, we describe a patient with func- tional lymph nodes and pulmonary metastases from a papillary thyroid cancer. CASE REPORT A 39-year-old woman was hospitalized on 1997 be- cause of chest pain, progressive dyspnea, and diffuse micronodular lung disease on chest X-ray. Computed tomography (CT)-guided biopsy was done, and pathology revealed the presence of metastases of papillary thyroid cancer in its follicular variant. Cervical palpation was without obvious abnormalities, and no clinical signs of dysthyroidism were noted; the serum level of TSH was 1.1 µIU/ml (normal range: 0.25–4.5). Ultrasonography revealed the presence of an infracentimetric hypoechoic nodule on the left lobe basis with several cervical lymph nodes on the jugular chain. Pin-hole thyroid scan was obtained 20 minutes after administration of 111 MBq (3 mCi) of Tc-99m pertechnetate, using a Sophy gamma camera DS7, and showed a homogeneous thyroid uptake, with the presence of extrathyroidal uptake foci indicating lymph nodes accumulation (Fig. 1). These foci located in both the left lateral compartment and central compart- ment with extension to the upper mediastinum. Consider- ing the known pulmonary metastases, a parallel-hole collimator scintigram, including both cervical and tho- racic regions, was acquired 1 hour later, and revealed pulmonary accumulation of Tc-99m pertechnetate (Fig. 2). I-131 scintigram, acquired 24 hours after oral admin- istration of 5.5 MBq (150 µCi), revealed the same findings (Fig. 3). Total thyroidectomy, including cervicocentral and upper mediastinum lymphadenectomy, and modified radical neck dissection was performed; pathology re- vealed the presence of multiple infracentimetric foci of follicular variant of papillary thyroid cancer on the left lobe, with a massive involvement and capsular effraction of the excised lymph nodes. I-131 scintigraphy performed Preoperative scintigraphic visualization of lymph nodes and pulmonary metastases from papillary thyroid carcinoma Sami BOUGHATTAS,* Habib HASSINE,* Nadia ARIFA,** Kaouther CHATTI,* Maryem DEGDEGUI,* Mohammed ABDELKEFI*** and Habib ESSABBAH* *Department of Nuclear Medicine, Sahloul’s Hospital, Sousse, Tunisia **Department of Radiology, Sahloul’s Hospital, Sousse, Tunisia ***Department of Otolaryngology, Farhat Hached’s Hospital, Sousse, Tunisia Preoperative accumulation of Tc-99m pertechnetate and radioiodine in metastases of well- differentiated thyroid carcinoma is uncommon. We report herein the case of a 39-year-old woman with occult papillary thyroid cancer revealed by widespread miliary lung metastases. Ultrasonog- raphy revealed the presence of an infracentimetric hypoechoic nodule and cervical lymph nodes. Scintigraphy, realized with Tc-99m pertechnetate and I-131 prior to thyroidectomy, failed to delineate the primary thyroid tumor, but revealed functional cervical nodes on the central and left lateral compartments, with pulmonary accumulation. Key words: thyroid cancer, metastases, Tc-99m pertechnetate, I-131