Case Author(s): Sam Wang, M.D., and Jerold Wallis, M.D. , 6/10/97 . Rating: #D2, #Q4

Diagnosis: Hypertrophic osteoarthropathy

Brief history:

Woman with a lung mass.

Images:

Anterior and posterior images

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Full history/Diagnosis is available below

Diagnosis: Hypertrophic osteoarthropathy

Full history:

Woman with a newly diagnosed posterior right upper lobe lung mass, being evaluated for metastatic disease.

Radiopharmaceutical:

Tc-99m MDP

Findings:

Delayed whole body images demonstrate linear cortical uptake of the radiopharmaceutical in the lower extremities. The effect is also seen to a lesser degree in the distal upper extremities.

Mild uptake at the right first rib costo-chondral junction is not contiguous with the lung mass on chest CT (not shown). This is a common site for degenerative change, and is relatively unlikely to represent a solitary metastatic focus.

Discussion:

Hypertrophic osteoarthropathy on bone scintigraphy is generally characterized by symmetric diffusely increased cortical uptake in the metaphysis and diaphysis of the tubular bones of the extremities. Pulmonary causes of hypertrophic osteoarthropathy may include malignant neoplasms (e.g., bronchogenic carcinoma, a few benign neoplasms (e.g., benign pleural fibroma), and chronic inflammation (e.g., pulmonary abscess, cystic fibrosis, interstitial fibrosis). Other causes of hypertrophic osteoarthropathy include inflammatory bowel disease, chronic liver disease, or congenital heart disease.

ACR Codes and Keywords:

References and General Discussion of Bone Scintigraphy (Anatomic field:Skeletal System, Category:Misc)

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Case number: bs077

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