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A 59-year-old woman presented with fever for 2 weeks. The patient had end-stage renal disease and was undergoing dialysis therapy for 10 years. Plain radiographs revealed extensive calcification in the subcutaneous tissues of the shoulders, thighs, and hips. In this case, TC-MDP bone scan detected all sites of subcutaneous metastatic calcification in one sweep. Ga-citrate scintigraphy was also performed and showed similar uptake at the same locations as those revealed by the bone scan, suggesting the existence of an inflammatory process at the sites of metastatic calcification.

An abnormally increased uptake of the bone-seeking agent is rarely observed in structures other than the bone and urinary track on bone scintigraphy. The general etiologies of soft tissue uptake can be explained by heterotopic ossification or dystrophic and metastatic calcification. We report a case of serendipitous visualization of the entire colon on bone scintigraphy. Diffuse colonic uptake was detected on the whole-body bone scan in a patient with biopsy-proven sigmoid colon cancer. Additional imaging studies clearly showed direct bladder invasion of the sigmoid colon cancer. Imaging findings with a brief review of the literature are presented in this article.

Metastatic calcifications according to histopathologic and scintigraphic findings have been well-defined. The authors report a postoperative case of hyperparathyroidism with multiple metastatic calcifications in the lung, kidney, stomach, heart, and vessels that were primarily detected by bone scintigraphy and demonstrated by CT. Tc-99m MDP bone scintigraphy showed a markedly increased accumulation of radioactivity diffusely throughout the lung, left ventricular wall, both kidneys, and the gastric cardia and body. In the lung, plain films showed almost normal lung. CT, however, demonstrated patchy, slightly increased densities in the lung bilaterally. Cardiac CT indicated a considerably increased density of the ventricular myocardium and remarkable calcification in or near the atrioventricular septum or annulus fibrosus. Upper abdominal CT demonstrated increased densities diffusely throughout the gastric mucosa and renal cortex. Only vascular calcifications were depicted by plain films. Using both bone scintigraphy and CT provides accurate information about each lesion and each tissue, allowing precise diagnosis of even a questionable lesion in the early stage of metastatic calcification. Early diagnosis and early therapy offer the best chance for cure or palliative therapy.

A 51-year-old woman on peritoneal dialysis for chronic renal failure secondary to diabetic and nonsteroidal anti-inflammatory drug nephropathy was referred for a Tc-99m MDP bone scan to assess firm subcutaneous plaques in the sacral and gluteal regions. This showed extensive superficial tracer localization in the subcutaneous tissues as well as visceral tracer activity in the myocardium, lungs, stomach, and kidneys. These findings were typical for calciphylaxis (calcific uremic arteriolopathy), a form of metastatic calcification encountered in patients with chronic renal failure that is characterized by subcutaneous soft tissue calcification, painful ulcerations, high morbidity, and mortality. Treatment with sodium thiosulfate resulted in dramatic scintigraphic improvement.

Hyperparathyroidism and renal osteodystrophy are the disorders usually associated with metastatic calcifications, including tumoral-calcinosis-like calcification in soft tissue in dialysis patients. Tumoral calcinosis is a hard, juxta-articular mass comprised of septal, thick connective tissue and cavities filled with a dense milky substance. The authors report plain radiographic, CT, and scintigraphic findings of a large tumoral-calcinosis-like metastatic calcification accompanying renal osteodystrophy in a renal dialysis patient. This rare form of metastatic calcification and renal osteodystrophy as a background condition were demonstrated on bone imaging.

Purpose Clinical and scintigraphic findings are described in a patient with unexpected diffuse lung uptake on bone scan after a heroin overdose. Methods The patient's Tc-99m MDP bone scan is reviewed along with the pertinent clinical history and laboratory findings. Results Marked diffuse and symmetric lung uptake is present on bone scintigraphy in a patient with a history of acute renal failure and a markedly elevated calcium-phosphate product but normal renal function and laboratory values at the time of the examination. Conclusions The incidental observation of metastatic calcification by bone scintigraphy is important, because it may aid in the diagnosis of a previously unsuggested elevated calcium-phosphate product, renal failure, or both. Furthermore, the intensity of tracer localization on bone tracer-specific imaging may help evaluate the activity of the metastatic calcification process.

Metastatic calcification associated with renal failure is well described. Bone scanning agents accumulate to various degrees within extraskeletal sites of metastatic calcification. The authors describe a patient with polycystic kidney disease resulting in renal failure, with the subsequent development of secondary hyperparathyroidism and metastatic calcification. Bone scintigraphy revealed abnormal uptake in both lungs, the right leg, and the right hand.

Purpose This case report describes the clinical, scintigraphic, and pathologic findings in a patient with an unexpected finding of a cutaneous malignant melanoma. Method Multiple imaging studies were done, as was a pathologic examination of a suspicious pigmented lesion on the patient's back. Result A Tc-99m MDP bone scan showed diffuse uptake in the skeleton, lungs, kidneys, and stomach. Conclusion Metastatic calcification, as shown by isotope scintigraphy, is an unusual manifestation of metastatic cancer from a primary cutaneous melanoma.

Metastatic calcification related to renal failure has been well described. There is uptake of bone-scanning agents at extraskeletal sites in metastatic calcification. A 34-year-old man with end-stage renal failure was treated with hemodialysis. He noticed a painful lump over his right shoulder. Anterior and posterior whole-body bone scintigraphy images revealed markedly increased uptake in the heart, right shoulder, and medial part of the left shoulder. A biopsy of the right shoulder area showed metastatic calcium deposition.

Tc-99m HMDP bone scintigraphy clearly demonstrated metastatic calcification in a lung and stomach in a patient with renal failure and hypercalcemia. Ga-67 citrate scintigraphy showed increased lung activity, but failed to demonstrate the stomach. The difference in uptake between Ga-67 citrate and Tc-99m HMDP in the regions of metastatic calcification could suggest there is a different uptake mechanism at various sites of metastatic calcification.

Metastatic calcification has been reported in several disease entities, including chronic renal failure. Various imaging modalities have been shown to be useful in the detection of metastatic soft tissue calcification. Radionuclide imaging may detect metastatic soft tissue calcification more readily than routine diagnostic modalities and be a valuable noninvasive method to establish an early diagnosis in high-risk patients. The authors report a patient with extensive soft tissue metastatic calcification who had a myriad of clinical symptoms. The extensive calcification was detected with a radionuclide imaging.

Bone scintigraphy is a sensitive imaging method for detecting metastatic calcification in end-stage renal disease. Common areas of calcium deposition include the blood vessels, periarticular soft tissues, lungs, stomach, kidneys, and the myocardlum. A short discussion and an interesting case of metastatic calcification in end-stage renal disease (ESRD) are presented.

Several physiologic and pathologic conditions demonstrating extraosseous localization of bone scanning agents have been described, including metastatic calcification of the soft tissues secondary to metabolic disorders, malignancies, and chronic renal failure. However, extraosseous uptake in primary oxalosis has not been documented, although scintigraphic uptake pattern in a patient with primary oxalosis has been described. Oxalosis (Hyperoxaluria) is an autosomal recessive genetic disorder of glyoxylate metabolism. Type 1 (glycolic aciduria) is caused by the deficiency of 2-oxoglutarate; glyoxylate carboligase results in excessive urinary excretion of oxalic, glycolic, and glyoxylic acids

Two patients without histories of cancer underwent Tc-99m MDP bone scans as part of evaluations of pain and abnormal laboratory and radiologic findings. Both scans showed abnormal soft tissue uptake in tumor deposits and in visceral organs associated with hypercalcemia and metastatic calcification. One scan showed diffuse increased bone uptake (superscan pattern), and the other revealed focal metastatic bone uptake. Adenocarcinoma of unknown primary (AUP) origin was subsequently identified in both patients. AUP occurs in multiple organs more than 50% of the time, with bone involvement in 4% to 31% of cases. The patients described here reflect the variety of patterns of osseous and nonosseous uptake of diphosphonate bone agents in patients with AUP.

A child with cystinosis was known to have cystine crystals in the thyroid and kidneys. While she was being evaluated for a pulmonary infiltrate, a bone scan was performed that showed uptake in the lungs, but not in the thyroid. These findings confirmed that the lung uptake was due to metastatic calcification and not due to cystine crystal deposition in the lungs.

A whole body bone scan obtained on a 21-year-old woman with sickle cell disease and chronic renal failure showed localization of the radionuclide diffusely in the stomach. The localization of the radionuclide represented metastatic calcification of the stomach caused by secondary hyperparathyroidism.

Metastatic soft tissue calcification is known to occur in hypercalcemia and is usually present in the kidneys, stomach and lungs. 1--3 This case presents two unusual features: 1) ectopic parathormone production in association with poorly differentiated lymphocytic lymphoma; and and 2) uptake of 99mTc-pyrophosphate in the liver in the absence of demonstrable abnormality at autopsy. The more usual sites of metastatic calcification also showed uptake of the radionuclide. We will discuss metastatic soft tissue calcification, ectopic parathyroid hormone production, hypercalcemia in malignancy and bone scan agent localization in soft tissues.

SPECT was used to identify a focal accumulation of cardiac calcification using Tc-99m MDP in a patient with an arrhythmia and known metastatic calcification elsewhere.

Abnormal accumulation of Tc-99m MDP in the lungs and stomach was observed in a patient with multiple myeloma and refractory hypercalcemia. There was no roentgenographic evidence of calcification. At postmortem examination, the presence of amyloid deposits was confirmed in both organs, while the corresponding metastatic calcification was demonstrated only in the gastric mucosa. It seems likely that, in our case, soft-tissue localization of bone-seeking agent was attributable to the presence of amyloid deposits rather than metastatic calcification. No cases showing the combined occurrence of amyloid deposition and metastatic calcification in soft-tissues have previously been demonstrated to concentrate bone-seeking agent.

A case of multiple myeloma with associated intense radionuclide uptake in the lungs and stomach on bone scan is presented. There was no roentgenographic evidence of calcification, and the bone scan provided the only antemortem evidence of metastatic calcification.