Hiatal Hernia Depicted on Tc-99m Sestamibi Images: Myocardial Perfusion Imaging

A 68-year-old obese, hypertensive, diabetic woman with a history of intermittent bleeding from a hiatal hernia was examined and found to have anemia and exertional chest discomfort and dyspnea. After treatment of her anemia, she was referred for assessment of myocardial ischemia. The results of Tc-99m sestamibi rest and exercise stress myocardial perfusion images were normal. Extracardiac tracer accumulation was identified near the base of the heart on the rest study, which correlated in location to a large hiatal hernia on radiographs. Localization of Tc-99m sestamibi within the stomach likely represented reflux of tracer from the duodenum. Other considerations include free pertechnetate secretion from the gastric mucosa or gastric bleeding during tracer injection.