Free Technetium Simulating a Solitary Hepatic Defect on Technetium-99m Liver Scans

Sulfur colloid, poorly labeled with Tc-99m sodium pertechnetate, (“free tech”) produced liver scans on two patients that were each initially interpreted as demonstrating a solitary hepatic defect. Uptake in adjacent gastric mucosa created an appearance that simulated a mass in the left lobe of the liver. In both cases, the liver was literally cleared of suspicion when delayed scans performed several hours later showed gastric emptying into the small intestine. Subsequent thin layer chromatography confirmed adulteration of the Tc-99m sulfur colloid with Tc-99m sodium pertechnetate.