Case Author(s): Samuel Wang, M.D. , . Rating: #D3, #Q3

Diagnosis: Dermatomyositis

Brief history:

76-year old man with complaints of neck pain and neck and bilateral upper extremity weakness. The patient also has a skin rash.


Anterior and posterior images.

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View second image(xr). Anterior chest.

View third image(ct). CT of liver.

Full history/Diagnosis is available below

Diagnosis: Dermatomyositis

Full history:

76-year old man admitted to the hospital with complaints of dysphagia and gastrointestinal bleeding. The patient also has complaints of neck pain as well as neck and bilateral upper extremity weakness. The patient has been unable to raise his hands over his head for the last month. Upper endoscopy and biopsy demonstrated gastric antral adenocarcinoma. The patient also had prostate biopsy, which demonstrated adenocarcinoma. Abnormal laboratory values included CK of 1653 (normal 30-22), LDH of 441 (normal 100-250), and SGOT of 173 (normal 11-47). PSA was 93. This patient also had a maculopapular, scaling, eczematous skin rash.


Tc-99m MDP


Bone scintigraphy demonstrates diffuse soft tissue uptake around the neck and shoulders. Plain film of the chest demonstrates no calcifications in the soft tissue, although there is some prominence of the soft tissues in the shoulder girdle. The CT study demonstrates liver metastases.


Common and uncommon causes of skeletal muscle uptake on bone scintigraphy are electrical burns (including cardioversion), muscle trauma, myositis ossificans, peripheral vascular disease with ischemia, rhabdomyolysis, polymyositis/dermatomyositis, iron dextran injection, and calcific tendinitis.

This patient's shoulder pain and weakness is consistent with polymyositis but is not specific. With the characteristic skin rash, however, dermatomyositis is most likely. The dermatomyositis is almost certainly paraneoplastic in this patient with gastric adenocarcinoma and hepatic metastases.

There are five types of poly/dermatomyositis. Type I is primary idiopathic myositis. Type II is primary idiopathic dermatomyositis. Type III is either, associated with neoplasm (approximately 10% of cases), especially in older patients. Type IV is either, associated with vasculitis in children. Type V is either, associated with collagen vascular disease (approximately 30% of cases).


The patient underwent partial gastrectomy and will undergo chemotherapy, which should also treat the dermatomyositis. No specific treatment for the dermatomyositis is planned (steroids are the usual form of treatment).

ACR Codes and Keywords:

References and General Discussion of Bone Scintigraphy (Anatomic field:Skeletal System, Category:Other generalized systemic disorder)

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Case number: bs056

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