IAEA Resource Listings
2012
Persistent cough and hemoptysis. Bone scan 99mTc-MDP.
Case presentations:
Male.
64 y.o.
Presents to the hospital with persistent cough and hemoptysis.
Heavy smoker and has lost about 4 kg weight during the last 3 months.
Teaching points:
Lung cancer is the third most common cause of bone mets after breast and prostate cancer. Other primary solid malignancies with frequent extension to bone include: melanoma, renal Ca, thyroid Ca.
The bone scan is not a specific procedure to detect malignant involvement, however type and distribution of lesions are often characteristic.
Benign conditions mimicking bone mets include: fractures, benign tumors, Paget disease, and some metabolic disorders.
The bone scan is a highly sensitive, inexpensive procedure for complete evaluation of the whole skeleton and it forms part of general oncologic work-up in malignancies known to have bone affinity or in patients with any malignant condition suffering from bone pain. -Hypertrophic osteoarthropathy(HOA) is a clinical syndrome of clubbing of the fingers and toes, enlargement of the extremities, and painful, swollen joints.
HOA is characterized by symmetric periostitisinvolving the radius, fibula, femur, humerus, metacarpals, and metatarsals. The syndrome can be primary (5%) or secondary (95%). (More teaching points in the case).
2012
Woman with persistent low back and pelvic pain. Bone scan 99mTc-MDP.
Case presentation:
Female.
67 y.o.
Presentsto tothe thehospital hospital with with persistent persistentlow lowback back and andpelvic pelvicpain pain.
History Historyof ofcolon colon cancer cancerwith withsurgical surgicaland andradiation radiation treatment treatment5 5 years yearsbefore before.
No other othersymptoms symptoms, no , no weight weightloss loss.
Physical examination reveals good general condition.
Plain X-ray shows moderate spondylosis, no other remarks.
Laboratory tests within normal limits.
Teaching points:
Spontaneus fractures (usually secondary to minimal trauma) are not rare in posmenospausal women due to loss of bone mineral matrix.
Radiotherapy can also produce alteration of bone matrix.
The bone scan pattern is tipycal and should not be confused with bone metastases.
Sacrum fractures usually adopt the characteristic "H" pattern.
Other lesions of the iliopubic and ischiopubic branches as well as vertebral and rib fractures are frequent.
2011
99mTc-MDP Uptake in Liver Metastases in a Patient with Gastric Carcinoma.
Case presentation:
Male.
67 y.o.
Complaint:abdominal pain for the past 4 months.
Initial treatment: as if viral gastroenteritis.
Evolution: persistent abdominal pain, mass sensation and gastrointestinal bleeding.
Blood tests: hemoglobin 7.7 g dl^(-1), whiste blood cell count 1600, neutrophil 310, platelets 55000.
Blood smear: immature granulocytes ando some nucleated red blood cells (suggestive of marrow infiltration by tumor).
Upper gastrointestinal endoscopy: 4cm corporo-antral gastric ulcer, Bormann III; gastric mucosa biopsy: intestinal-type adenocarcinoma, moderately well differentiated.
Abdominal ultrasound: Liver metastases, omental cake, retroperitoneal lymph node metastases.
Teaching points:
Regarding extraosseous Tc-99m MDP uptake:
First rule out artifact: i. free pertechnetate uptake by stomach , thyroid and salivary glands. ii. radiopharmaceutical colloid formation uptake by liver, spleen and lungs. iii. Aluminium breakthrough. iv. Contamination. v. Gamma camera malfunction.
(More teaching points in the case).
2011
Patient on antibiotics with persistent fever and diarrhea. 111In.oxine-labeled leukocytes.
Case presentation:
Male.
66 y.o.
Constant diarrhea and persistent fever.
The patient is on antibiotics.
Teaching points:
Colonoscopy indicated evidence for pseudomembranous colitis. The patient demonstrated clinical improvement following antibiotic coverage for Clostridium difficile.
2011
Patient with diagnosis of “ulcerative colitis”. 99mTc-HMPAO-WBC Scintigraphy.
Case presentation:
Male.
72 y.o.
Recent diagnosis of ulcerative colitis.
Therapy with mesalazin, steroids and immuno suppressors, ensuing adequate control of symptoms.
After being virtually symptom-free for 3-4 months:fever, diarrhoea,and abdominalpain.
Hospital admission with preliminary diagnosis of “septic state in patientwithacute ulcerative colitis”.
Acute-phasemarkers: ESR 58;C-Reactive Protein 77.8; Leukocyte count6700/μL.
Teaching points:
In radionuclide infection imaging, a creful evalutaion of total body scan is essential in order to detect other unsuspected areas of infection, even in patients knownto have an existing infection.
2011
Athlete who reports persistent bilateral lower extremity pain. 99mTc-MDP scan.
Case presentation:
Female.
15 y.o.
Track athlete who reports persitent biulateral lower extremity pain.
Teaching points:
The mild to moderately increased activity at the mid shaft, posteromedial, periosteal aspects of the tibiae in an elongated distribution on the delayed images with symmetric perfusion and blood pool activity illustrates the classic findings of tibial stress syndrome otherwise know as “shin splints”.
This entity can be differentiated from a stress fracture, which generally demonstrates a discrete, fusiform distribution of more intensely increased activity on the delayed images. Also, stress fractures often demonstrate increased focal activity on the perfusion and blood pool images.
Distinction of these two entities is clinically useful in the young athlete as the required period of healing is significant longer with a stress fracture.
2011
Onset of fever a few days after the procedure of chemoembolization. 99mTc-HMPAO-WBC scintigraphy
Case presentation:
Female.
70 y.o.
Onset of fever a few days after the procedure of chemoembolization.
May 2000: liver transplantation because of hepatocellular carcinoma (HCC).
August 2007: percutaneous trans-arterial chemo-embolization for relapse of HCC.
Onset of fever a few days after the procedure of chemoembolization.
Teaching points:
Radionuclide imaging for suspected infection in the abdominal area should always be completed with abdominal SPECT-CT, in order to correctly identify and localize the anatomical site if the infective focus.