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Given a true superscan, clinical history is frequently all that is necessary to suggest the correct diagnosis. Prostate carcinoma is the most common of the metastatic causes, with breast and lymphoma as other less likely possibilities. Renal disease and hyperparathyroidism (primary or secondary) lead the list of metabolic causes of superscans. Typical histories would include an elderly male with a significantly elevated PSA (suggesting metastatic prostate carcinoma) or a patient with chronic renal failure and/or laboratory evidence of renal disease (suggesting a metabolic etiology). In this teaching file case, the patient's young age, history of chronic renal disease, and abnormal laboratory values clearly point to metabolic disease as the cause of his superscan. Without this clinical information, however, metastatic disease would remain in the differential, although widespread metastases typically show less involvement of the extremities and are usually not completely uniform and symmetric compared to metabolic bone disease.
References: Datz FL: Handbook of Nuclear Medicine, 2nd ed. St. Louis, Mosby, 1993, pp67-69. Datz FL, et al: Nuclear Medicine, A Teaching File, St. Louis, Mosby, 1992, p26. Mettler FA, Guiberteau MJ: Essentials of Nuclear Medicine, 3rd ed. Philadelphia, W.B. Saunders, 1991, p217. Thrall JH, Ziessman HA: Nuclear Medicine, the Requisites, St. Louis, Mosby, 1995, pp102,120.
References and General Discussion of Bone Scintigraphy (Anatomic field:Skeletal System, Category:Metabolic, endocrine, toxic)
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