Case Author(s): Mike Roarke, M.D. and Henry Royal, M.D. , 2/2/96 . Rating: #D2, #Q3
Diagnosis: Lower extremity deep venous thrombosis
Brief history:
70 year old woman with history of ovarian carcinoma.
Images:
Anterior and posterior whole body images.
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Full history/Diagnosis is available below
Diagnosis: Lower extremity deep venous thrombosis
Full history:
This patient is a 70 year-old woman who underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy for ovarian carcinoma in 12/95. She now presents with marked lower extremity edema. Color Doppler ultrasound examination revealed thrombi in the deep left pelvic and lower extremity veins.
Radiopharmaceutical:
20.0mCi 99mTc-MDP
Findings:
Increased soft tissue tracer activity is seen throughout the left leg, which is quite enlarged. Mildly increased activity is seen in multiple joints, which were most consistent with degenerative change. No scintigraphic evidence of osseous metastatic disease was seen.
Discussion:
This case illustrates the importance of evaluating soft tissue uptake on bone scintigraphy examinations. The presence of extensive lower extremitiy deep venous thromboses, with the risk of pulmonary embolism, is certainly a more immediate threat to the patient than the osseous abnormalities. In such cases, the patient's physician should be promptly informed of the findings, especially when the diagnosis of deep vein thrombosis is not yet suspected clinically. Differential diagnostic considerations in this case include lymphedema and soft tissue inflammation/infection.
ACR Codes and Keywords:
References and General Discussion of Bone Scintigraphy (Anatomic field:Vascular and Lymphatic Systems, Category:Misc)
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Case number: bs050
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