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99mTc-MAA total body imaging of patent right-to-left shunt with invisible brain activity.

Generally, the presence of brain activity in technetium-99m macro aggregated albumin (99mTc-MAA) total-body imaging is considered a hallmark sign of patent right-to-left shunt. Herein, we present a unique case of a patient with Eisenmenger syndrome, whose 99mTc-MAA total-body imaging showed increased extrapulmonary activities only in the abdomen, pelvis, and both lower extremities and no activity was observed in the brain and upper extremities. The patient previously underwent a Potts shunt operation, which is a surgical approach to perform a side-to-side anastomosis between the left pulmonary artery and the descending aorta to decompress pulmonary hypertension and right ventricular overload. This case presents a unique pattern of 99mTc-MAA total-body imaging for the evaluation of the patency of right-to-left shunt after Pott shunt operation, intentionally made for therapeutic use.