Achalasia diagnosed by Tc-99m pertechnetate scintigraphy

A 73-year-old patient presented a Tc-99m scintiscan with a focal tracer accumulation left and caudal of the thyroid gland. Further investigations with sonography, CT, esophagoscopy and barium swallow provided the diagnosis of achalasia as the reason for focal Tc-99m retention caudal of the thyroid gland, Explanation for Tc-99m accumulation within the esophagus may be the nonspecific accumulation of Tc-99m not only in the thyroid gland bur also in the salivary glands. Excretion of the tracer follows with the saliva. Structural and motor disorders of the esophagus can thus lead to focal tracer retention within the esophagus simulating thyroid tissue.