Case Author(s): Samuel Wang, M.D. and Barry A. Siegel, M.D., 1/12/96 . Rating: #D3, #Q3

Diagnosis: Radiation nephritis

Brief history:

33-year-old woman with history of breast carcinoma and known osseous metastatic disease.


Anterior and posterior images from current study.

View main image(bs) in a separate image viewer

View second image(bs). Anterior and posterior images performed 10 months previously.

Full history/Diagnosis is available below

Diagnosis: Radiation nephritis

Full history:

33-year-old woman with a history of breast carcinoma diagnosed 14 months previously who had undergone a left breast excisional biopsy, 4 courses of chemotherapy, and 1 course of radiation therapy to the thoracolumbar spine (from the level of the 8th thoracic vertebra down to and including the lumbar spine) for osseous metastases. The total radiation dose to the spine was 3500 cGy, administered over 20 days.


Tc-99m MDP


Bone scintigraphy performed 4 months prior to the radiation therapy to the thoracolumbar spine demonstrated focal areas of increased activity most consistent with metastases in the 10th, 11th, and 12th thoracic vertebrae, the 2nd, 3rd, and 4th lumbar vertebrae, and the right 5th and 8th ribs. Repeat bone scintigraphy was performed 6 months after the radiation treatment. There was a decrease in the intensity of the activity in the known thoracic and lumbar vertebral metastases. In addition, the study revealed 2 new focal areas of increased activity in a linear distribution parallel to the 12th thoracic vertebra. This new abnormality appeared separate from the vertebra. Radiographs demonstrated compression and sclerosis of the vertebral body without extension into the soft tissues or soft tissue calcifications. The scintigraphic findings were felt to represent acute segmental radiation nephritis involving the superomedial aspects of the kidneys.


The kidneys are highly radiosensitive organs. Radiation-induced injury occurs in proportion to the radiation dose and the volume of renal tissue exposed. In general, radiation damage to the kidneys occurs with dosages greater than 2300 cGy over approximately a five-week period. Acute radiation nephritis occurs at 6-13 months and chronic radiation nephritis occurs at 18 months to several years after treatment. Patients on chemotherapy have a greater propensity for injury. This case illustrates the incidental scintigraphic features of acute segmental radiation nephritis in a patient who received radiation therapy to the thoracolumbar spine. The geometric borders of the area of increased activity correspond to the lateral limits of the radiation port, which includes the superomedial aspects of the kidneys. This intensity of activity on 2-hour delayed images reflects the abnormal retention of radiotracer within the renal parenchymal, which has undergone acute radiation damage.

references: 1) Dewitt, et al. International J Radiation Oncol and Biology Physics 1990;19:977-983 2) Palestro, et al. Clin Nucl Med 1988;13:789-791

ACR Codes and Keywords:

References and General Discussion of Bone Scintigraphy (Anatomic field:Genitourinary System, Category:Effect of Trauma)

Search for similar cases.

Edit this case

Add comments about this case

Return to the Teaching File home page.

Case number: bs053

Copyright by Wash U MO