Case Author(s): Charles Pringle, M.D., and Tom R. Miller, M.D. , 01/10/96 . Rating: #D3, #Q4

Diagnosis: Pathologic fracture of C-2 and lytic lesion of T-2

Brief history:

Neck pain for two weeks.


Anterior and Posterior whole body delay images

View main image(bs) in a separate image viewer

View second image(bs). Spot images

View third image(xr). Lateral radiograph of the cervical spine

View fourth image(ct). Axial computed tomography through C2

Full history/Diagnosis is available below

Diagnosis: Pathologic fracture of C-2 and lytic lesion of T-2

Full history:

This 69 year-old patient has a history of breast cancer treated with chemotherapy and radiation therapy 16 years ago. She now presents with neck pain for two weeks with no neurological deficit.


19.9 mCi Tc-99m MDP i.v.


The bone scintigraphy shows increased activity involving the C2 vertebral body, especially on the right side. There is also increased activity in the second thoracic vertebral body. Correlation of the plain radiographs with the scintigraphy showed a pathologic fractrue through the right side of C2. Also, a large lytic lesion involving much of the body of C2 and the base of the odontoid rocess is identified on the CT images. A CT scan of the thoracic spine showed a lytic lesion at T2 corresponding to the scintigraphiic finding. A single focus of increased activity in the right second rib most likely represents a benign post-traumatic lesion.


In this patient with a past history of breasat cancer, the most likely diagnosis is osseous metastases, although multiple myeloma cannot be excluded in view of the lytic nature of the lesions.


The patient was treated for metastatic breast cancer.

Major teaching point(s):

Bone scintigraphy of the upper cervical spine can be difficult to interpret, as in the present case. Findings in this area are often interpreted as due to degenerative disease.

ACR Codes and Keywords:

References and General Discussion of Bone Scintigraphy (Anatomic field:Skeletal System, Category:Neoplasm, Neoplastic-like condition)

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Case number: bs049

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