Case Author(s): J. Philip Moyers, M.D. and Keith C. Fischer, M.D. , 5/17/96 . Rating: #D2, #Q4
Diagnosis: Osteosarcoma, proximal fibula
Brief history:
This patient has continued leg
soreness after minor trauma approximately three
months previous.
Images:
Anterior and posterior whole body bone scintigrams
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View second image(bs).
Spot images of lower extremity
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Anterior image of the proximal fibula
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Lateral image of the proximal fibula
Full history/Diagnosis is available below
Diagnosis: Osteosarcoma, proximal fibula
Full history:
This 15-year old girl is 26 weeks
pregnant. Approximately three months prior to this
examination, the patient hit her ankle on a
table. The patient has had chronic dull pain since
and plain films were obtained.
Radiopharmaceutical:
10.3 mCi Tc-99m MDP
i.v.
Findings:
A focus of markedly increased
activity is demonstrated in the proximal right fibula
without evidence for other areas of increased
activity. The plain films demonstrate a destructive
lesion with production of an osteogenic matrix in the
proximal right fibula, consistent with an osteogenic
sarcoma.
Discussion:
Choice of adequate
radiopharmaceutical activity was predicated on the
fact that this was a pediatric-age patient who was
also 26 weeks pregnant. The amount of
radiopharmaceutical activity was felt to be adequate
to evaluate for metastatic disease from the
osteosarcoma. A Foley catheter had been placed to
decrease the amount of activity within the bladder
to decrease dose to the fetus. Also, the
catheter was placed for patient comfort during the
examination due to limited ambulation and need for
frequent voiding. Osteogenic sarcoma is a neoplasm
most often found in the pediatric-age group. The
most common sites of involvement are the distal
femur, proximal tibia, and proximal humerus,
respectively. Bone scintigraphy was performed to
evaluate for metastatic disease prior to resection.
Followup:
The patient is undergoing further
evaluation prior to resection of the proximal right
fibula.
Differential Diagnosis List
A focal area
of increased activity in the skeleton most commonly
falls under three general headings; tumor, infection,
or trauma. Given the radiographic findings, the
overwhelmingly likely diagnosis for this
focal area of increased uptake is osteogenic sarcoma.
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: bs060
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