Massive extracardiac thallium accumulation in pulmonary carcinoma.

A 77-year-old woman sought medical advice because ofsevere left upper arm pain oftwo months’ duration. The pain was intermittent and not always exertional. She denied history of chest discomfort. Past history included hypertension and smoking. Physical examination revealed left carotid bruit, normal heart sounds, diminished distal pulses and no localized neurologic signs. The electrocardiogram showed nonspecific S-T and T-wave changes. Because of her age, coronary risk factors, and evidence of peripheral vascular and carotid disease, the diagnosis ofeoronary artery disease was considered. She was exercised on the treadmill using the Bruce protocol. Exercise was terminated after 3.5 mm because offatigue. Peak heart rate was 102 bpm. She had no angina and there was no ischemic electocardiographic change. Initial and four-hour delayed thallium images are shown in Figure 1. There is massive thallium uptake in the left upper lung field. Subsequently, a chest x-ray film was obtained which showed a round lesion in the left upper lobe. CT scan showed that the mass entended laterally through the pleura, with bone destruction and extension to the soft tissues ofthe chest. There was also left hilar adenopathy. Needle aspiration biopsy showed anaplastic squamous cell carcinoma.