Lower gastrointestinal bleeding diagnosed by red blood cell scintigraphy in a patient with a left ventricular assist device

A patient with ischemic congestive heart failure, managed with a left ventricular assist device (LVAD) as a bridge to cardiac transplantation, developed hematochezia. This article illustrates the utility of Tc-99m-labeled red blood cell scintigraphy for identification of the lower gastrointestinal bleeding site in a patient with LVAD. The study initially showed a normal biodistribution of radiotracer, with expected activity in the sac of the LVAD and its cannulae, and later identified the bleeding from the sigmoid, permitting selective angiography and therapeutic embolization. There is a prior limited illustration of red blood cell scintigraphy in the presence of LVAD.