Somatostatin Receptor Scintigraphy in a Patient With Polycystic Disease and Highly Increased Tumor Markers

A 61-year-old man with end-stage renal failure resulting from polycystic disease (hepatic and renal) who was on hemodialysis was investigated because of the development of ascites. During the previous 2 months, he had extremely high levels of carbohydrate antigen (CA) 19-9 (4951.1 U/mL [normal range, 0–37 U/mL]) and CA 50 (4365.6 U/mL [normal range, 0–25 U/mL]). Ultrasound, CT, and MRI, as well as endoscopy, were negative for tumor. He was referred to our Nuclear Medicine Department to be investigated for a possible neuroendocrine pancreatic tumor by In-111 pentetreotide scintigraphy. An upward displacement of the diaphragm into the thorax was noted such that the spleen appeared in the left lower lung field and the liver at the site of the right lower lung field. These topographic changes were explained by the ascites.