Unusual uptake of radioiodine in the small bowel in a patient with thyroid cancer and bowel malrotation.

Whole-body radioiodide scan is an essential procedure in the evaluation of radioiodine-avid metastatic foci in patients with differentiated thyroid carcinoma. Normal physiologic distribution of the radiotracer includes the stomach and colon, but the small intestine is not often seen. Gastrointestinal anatomic variants may be associated with atypical activity on I scan. We report here a case of intestinal malrotation with associated I uptake in the small intestine. Careful correlation of planar imaging with SPECT/CT revealed the likely malrotation as well as small bowel uptake superimposed over normal colonic uptake. This finding was occult on prior I scan.