Diaphragmatic Paralysis Simulating Pulmonary Infection on Gallium-67 Scan

Abstract

Ga-67 is a useful agent for imaging infection, especially in the chest, but is not so reliable in the abdomen because of physiological bowel activity. A 64-year-old man with fever of unknown origin received a Ga-67 scan for survey of any occult infection focus. Focal Ga-67 accumulation was noted in the left lower chest region on the 24-hour image, but a different pattern of radioactivity was shown on the 48-hour image after bowel cleansing. On review of the chest radiographs and history, we found bowel activity in the left lower chest secondary to diaphragmatic paralysis masqueraded as pulmonary infection. Diaphragmatic paralysis should be considered as a differential diagnosis of abnormal activity in the chest on Ga-67 scan.