Search

A "super scan" pattern detected on bone scintigraphy usually indicates either metabolic bone disease or diffuse metastases. We report a rare case of a 45-year-old man with recurrent episodes of syncope of 10 years' duration in whom bone scintigraphy showed a super scan with an axial skeleton distribution of uptake. Bone marrow biopsy established the diagnosis of systemic mastocytosis. The few reports in the literature of super scans associated with systemic mastocytosis showed diffuse axial and appendicular increased uptake. The present case shows a super scan involving the axial skeleton, which led to the diagnosis of systemic mastocytosis.

Limping is a frequent occurrence in children and may be caused by various conditions, including trauma, inflammation, infection, and malignancy. Nontraumatic avascular necrosis of the tarsal bones should be included in the differential diagnosis. Accumulated data have supported the superiority of bone scans to radiography in the early diagnosis of avascular necrosis. Bone scintigraphy is a useful tool for investigating pain when symptoms, laboratory examinations, and radiography do not point to a specific diagnosis. In the early phase of disease, bone scans may demonstrate decreased tracer uptake (photopenic region), subsequently a hot area is seen during the reparative process. Although magnetic resonance imaging has important implications in the diagnosis of avascular necrosis, bone scintigraphy with its ready availability has a significant role as a primary tool in the evaluation of a limping child.

(18)F-FDG uptake in the thymus, mainly related to hyperplasia after chemotherapy, has been described. Thymic uptake can challenge the accurate assessment of cancer patients by (18)F-FDG imaging. The present study defines the incidence, patterns, and intensity of thymic (18)F-FDG uptake in relationship to age and time after treatment in a large cohort of patients.A total of 559 consecutive (18)F-FDG PET/CT studies in 160 patients (86 men, 74 women; age, 3-40 y) performed at baseline, during treatment, at the end of treatment, and during follow-up were retrospectively reviewed. PET/CT studies were assessed for the presence or absence (T+ or T-, respectively), pattern, and intensity (SUVmax) of increased (18)F-FDG uptake in the anterior mediastinum, localized by the CT component to the thymus. The overall incidence of (18)F-FDG avidity in the thymus in relationship to the patient's age and time after treatment administration were statistically evaluated.There were 137 of 559 T+ studies (25%), with equal sex distribution. T+ studies were found in significantly younger patients (20.6 +/- 9.3 y vs. 27.4 +/- 8.4 y, P0.001). Most T+ patients (60%) showed an inverted V pattern of thymic uptake, with additional unilateral mediastinal extension in 24% and focal midline uptake in 16% of studies. T+ studies were encountered in 80% of patients younger than 10 y, compared with 8% of patients in the 31- to 40-y age group. There were 17% T+ studies at baseline, 6% during treatment, 8% at the end of treatment, and 27%-40% during follow-up. The average SUVmax of thymic (18)F-FDG uptake was 3.73 +/- 1.22.Thymic (18)F-FDG uptake was found in 28% of the present study population, more frequently after treatment. T+ patients were significantly younger. Thymic uptake was found in 73% of untreated patients up to the age of 13 y and in 8% of patients in the fourth decade of life. Knowledge of this age- and treatment-related incidence of physiologic thymic (18)F-FDG avidity can reduce the number of potential pitfalls in reporting PET/CT studies in cancer patients.

Myositis ossificans is a rare condition characterized by the abnormal formation of bone in the soft tissue. It has been classified in 2 forms whether it follows trauma or not. The condition is usually confused with infection or malignancy of soft tissue according to the clinical setting. Radiography is the preferred method of initial imaging, but it may not detect the lesion in the first 1 to 2 weeks. Bone scintigraphy is the method of choice for early detection of the disease and for assessing the maturity of the lesion. We present the case of a 12-year-old boy with myositis ossificans of the thigh muscles demonstrated on bone scintigraphy, which was differentiated from malignancy on Tc-MIBI scintigraphy and hence, ulterior invasive investigation was avoided.

We report the case of 19-year-old woman with severe hypercalcemia who was evaluated with a bone scan to exclude bone metastases. Increased uptake in both lungs was detected on the bone scan. The patient's final diagnosis was systemic lupus erythematous (SLE). There is no reported pattern of bone scanning in SLE, and diffuse lung uptake has not been reported in these patients.

Placental transmogrification of the lung (PTL) is a rare, benign cystic disease of the lung, first described in 1979, that occurs in association with bullous emphysema and involves a single lobe of the lung. Few cases have been reported in the medical literature. Macroscopic and histologic f

A 41-year-old man with known Crohn's disease presented with chest pain and fever. Plain film and CT of the chest were normal, but bone scan and gallium scans showed intense sternal uptake. Surgery revealed staphylococcal osteomyelitis of the sternum. Following appropriate antibiotic treatment, the patient's symptoms resolved and follow-up gallium scans became normal. This is the first report of the association of sternal osteomyelitis and Crohn's disease, although other sites have been described. Sternal osteomyelitis has a high morbidity and the index of suspicion for this condition must be high even in the face of initially negative imaging.

Sternal malformations are rare congenital malformations of the chest wall. Only a few cases have been reported. Most cases are diagnosed shortly after birth and are reported only rarely in adults. The defects are usually detected on radiographs or computed tomographic (CT) scan. Bone scintigraphy usually has no role in the diagnosis of these congenital defects. Cleft sternum is one of the most common eternal malformations. It results from failure of midline fusion of the two parts of the sternum. It is seen in two forms, complete and incomplete, and it may present as an isolated form or associated with other congenital anomalies, such as cardiac or vascular defects. The defect is corrected surgically for cosmetic purpose and to protect the underlying exposed mediastinal structures. The authors report the case of a complete cleft sternum in an adult detected on bone scintigraphy.

Primary non-Hodgkin's lymphoma (NHL) of the larynx is very uncommon. It accounts for as many as 5% of extranodal NHLs and for fewer than 1% of all NHLs. Few cases have been reported in the literature. None of these studies evaluated the role of the Ga-67 scan in staging the disease and in assessing the response to treatment. The authors describe a 77-year-old woman with NHL of the larynx who was examined with a Ga-67 scan at baseline before starting treatment and at the end of six courses of chemotherapy. The results of Ga-67 imaging and computed tomography (CT) were correlated with clinical findings at the time of initial presentation and during follow-up.

A 28-year-old man was examined because of a mass in the right side of his neck. A thyroid scan with Tc-99m pertechnetate showed an area of decreased activity in the right lower lobe that corresponded to the palpable nodule. Because the fine-needle aspiration did not provide satisfactory specimens, the patient underwent surgery. The nodule was firmly attached to the right lobe and both were excised. A histologic analysis revealed that the cystic mass was consistent with an echinococcal cyst. Thyroid involvement by hydatid cysts, especially as a primary site, is very uncommon.

An 81-year-old man with prostate carcinoma and known lung and bone metastases underwent prostatectomy followed by radiotherapy 8 years previously. Whole-body bone scintigraphy demonstrated unexpected diffuse colonic uptake (a). The patient had suffered from recurrent urinary tract infection, haematuria, faecaluria and recurrent diarrhoea during the previous several months. Therefore, cystography was performed that revealed a fistulous communication between the bladder and the caecum (b). Most likely the fistula is related to the radiation therapy the patient had received in years past. Its presence explains the radionuclide flow from the bladder to the intestine as well as the low radionuclide concentration in the urinary bladder. A urinary fistula should always be considered when a communication between the gastrointestinal tract and the genitourinary system is detected or when the radionuclide is demonstrated in the surrounding tissue of the bladder. Most fistulas occur as a complication of abdominal surgery or trauma. A spontaneous fistula is usually the result of intra-abdominal inflammation or infection and is associated with higher mortality and morbidity rates as well as increased health care costs for diagnosis and treatment. [1–4]. It is of utmost importance to correlate this prominent imaging finding with patient history. References