PMC4896233_01
52-year-old woman with follicular thyroid carcinoma treated by subtotal thyroidectomy. Pre- (A, B) and Post-ablative (C, D) whole body and spot I-131 imaging performed at 8 and 9 weeks status post subtotal thyroidectomy respectively demonstrated residual activity in the thyroid bed (straight arrows in A-D). Post-ablative imaging (C, D) additionally demonstrated an intense focus of abnormal activity in the region of the gallbladder fossa (curved arrows in C, D), which was persistent on delayed imaging (see Fig. 2). Liver (arrowheads in C, D), bowel (dashed arrows in A-B), and bladder (tapered arrows in A-C) activity is also noted.
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An abnormal focus of increased activity was present in the region of the gallbladder fossa on 48 and 72 hour post-ablative imaging (Fig. 1).
52-year-old woman with follicular thyroid carcinoma treated by subtotal thyroidectomy. Delayed spot I-131 imaging performed at 11 days post ablative therapy. Intense focal activity (curved arrows) remains visible in the region of the gallbladder fossa. The liver (arrowheads) shows lower level diffuse activity. Anterior (A) and posterior (B) views are shown.
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Initially, this activity was felt to likely represent activity within the bowel near the hepatic flexure, however delayed imaging at 11 days post ablation demonstrated persistent activity in this area (Fig. 2).
52-year-old woman with follicular thyroid carcinoma treated by subtotal thyroidectomy. Intravenous contrast-enhanced abdominal CT performed 3 weeks following ablative therapy and whole body imaging demonstrated cholelithiasis (white arrowheads), but no evidence of hepatic metastases.
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Numerous calculi were noted in the gallbladder (Fig. 3).
52-year-old woman with follicular thyroid carcinoma treated by subtotal thyroidectomy. Abdominal sonogram performed 7 weeks after subtotal thyroidectomy and prior to ablative therapy demonstrated extensive cholelithiasis, with classic wall-echo-shadow sign (white arrows). The visualized portions of the liver (dark arrowheads) were normal in appearance.
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Abdominal ultrasound shortly thereafter also demonstrated extensive cholelithiasis (Fig. 4).