Bone scan
Musculoskeletal system
Case TypeClinical Cases
Authors
Covelli EM, Donnianni T, Sullo P, Manfredonia L, Mazzarella G, Belfiore G
Patient65 years, male
The patient presented with clubbing of the digits and swelling of the legs.
The patient presented with clubbing of the digits and swelling of the legs.
A total-body scan was performed 3 hours after administration of an i.v. bolus of tracer (740MBq 99mTc-labelled diphosphonate) in anterior and posterior views using a double-head gamma-camera (Philips/ADAC - Vertex plus) equipped with low-energy, very high resolution (VXHR) collimators.
Following traditional chest X-ray, a CT-scan (GE - PACE plus) with contrast medium was performed on the chest for study of the lungs after a thigh bone study without contrast media.
MRI (Eclipse Philips-Marconi 1.5T) was perfomed on the thigh bones with TSE T1- and T2-weighted images on the coronal and axial planes.
Bone scintigraphy showed abnormal intense symmetrical uptake in the inferior limbs - hypertrophic osteoarthropathy. The traditional chest X-ray and CT scan showed lung cancer. The CT images of the thigh bones showed low periosteal proliferation. MRI of the femurs was negative in all sequences except for a dishomogeneous signal.
Pulmonary hypertrophic osteoarthropathy is a syndrome of unknown aetiology, presenting with osteitis of the long bones, arthritis, and clubbing of the digits. It is frequently associated with lung cancer or other chronic pleural disease.
The literature reports 3% of cases of lung cancer associated with pulmonary hypertrophic osteoarthropathy in Europe.
In conclusion:
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URL: | https://www.eurorad.org/case/2171 |
DOI: | 10.1594/EURORAD/CASE.2171 |
ISSN: | 1563-4086 |