DMSA Case 3 Answers
1) Explain the unusual appearances
The patient is in advanced renal failure with a serum creatinine of 500. The concentration of tracer in the kidneys is poor and background uptake is high and tracer is seen within the lungs and liver.Normally only 3% of the DMSA should be seen in the liver at 3-4hours - i.e. very small amounts. When renal uptake of DMSA is very low, the liver may accumulate DMSA as an alternative excretory pathway.
DMSA renal uptake is highly pH-dependent and any cause of acidosis (such as renal tubular acidosis) can cause a lack of renal uptake. Click here for similar case, where the patient had mild renal impairment (Cr=180) but was acidotic due sepsis.
The text is entirely the opinion of the author and does not necessarily reflect that of RUH NHS Trust or the Bristol Radiology Training Scheme. Website content devised by Paul McCoubrie.