Case Author(s): Vreeland, M.D./Wallis, M.D. , 2/11/95 . Rating: #D2, #Q4

Diagnosis: Radiation-induced hypoplasia

Brief history:

20 year old man on steroids with back/hip pain


Spot views of the whole body

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View third image(xr). Plain films of the abdomen and pelvis.

Full history/Diagnosis is available below

Diagnosis: Radiation-induced hypoplasia

Full history:

20 year old man who is status post orthotopic heart transplantation in 1987 for an idiopathic cardiomyopathy. He also has a history of left-sided nephrectomy at the age of three for a Wilm's tumor, followed by radiation therapy. This study is being done to rule out avascular necrosis of the hip.


Bone Scintigraphy

(1) No scintigraphic evidence of avascular necrosis; the anterior pelvis views (not shown) also demonstrated normal uptake of tracer in the femoral heads.

(2) Hypoplastic left iliac wing and surgically absent left kidney, consistent with the patient's history.

Radiograph of the Abdomen:

(1) Contrast is seen in the normal appearing remaining right kidney and bladder.

(2) Multiple clips over the left abdomen confirm the surgical absence of the left kidny.

(3) Radiographs also confirm the hypoplastic left iliac wing.


Radiation damage to musculoskeletal tissues occurs initally from the vascular inflamation and subsequent fibrosis. Bone scintigraphy performed within weeks of radiation therapy may show increased uptake in the port area because of the inflamation. As weeks pass, fibrotic changes cause decreased blood flow to the port area, and subsequent bone scintigraphic evaluations would show nonanatomic areas of decreased uptake corresponding to the port. If high enough doses of radiation are used, especially in young children, radiation-induced hypoplasia will occur because of the cytotoxic effect to osteoblasts which occur with doses greater than 1200 rads. The younger the child, the more pronounced the asymmetry.

Approximately 2.5% of patients with Wilm's disease have hemihypertrophy, which is usually noted on the side of the body contralateral to the tumor. Hemihypertrophy should not be restricted to a port area, and generally has activity proportionate to bone mass.


Conservative treatment.

ACR Codes and Keywords:

References and General Discussion of Bone Scintigraphy (Anatomic field:Skeletal System, Category:Misc)

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Case number: bs018

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