Case Author(s): Lisa Oakley, M.D. and Tom R. Miller, M.D., Ph.D. , 10/17/97 . Rating: #D2, #Q4
Diagnosis: Metastatic Osteosarcoma
Brief history:
31 year-old male with shortness of breath for 3 months.
Images:
ANTERIOR AND POSTERIOR DELAYED WHOLE BODY IMAGES
View main image(bs) in a separate image viewer
Full history/Diagnosis is available below
Diagnosis: Metastatic Osteosarcoma
Full history:
31 year-old male, with osteogenic sarcoma of the left distal
femur treated by above the knee amputation with subsequent
chemotherapy nine years ago. He was lost to follow up and returns now
with a 3 month history of shortness of breath.
Radiopharmaceutical:
Tc99m-MDP
Findings:
The bone scintigrams show an above the knee amputation on the left as
well as lobulated, intense uptake in the chest conforming to
the expected outline of the pulmonary pleura and intense focal uptake at
the right acetabulum, and mild to moderate increased uptake in the
proximal right femur.
Discussion:
Soft tissue uptake of Tc99m-MDP can be seen in a wide range of disease
processes and is due to a variety of mechanisms.
Soft tissue uptake in the chest can be seen in malignant pleural
effusion where radiopharmaceutical has been found in the non-cellular
aspect of the effusion. Other possibilities include uptake in the lung
and pleura from bronchogenic carcinoma, radiation therapy to the chest,
radiation pneumonitis, lung metastases, tumor of the chest wall, breast
uptake, costochondral cartilage calcifiction, and lung uptake in the
setting of hypercalcemia
Followup:
A CT scan of the chest was performed which shows extensive calcified
pleural metastatic disease and a large sclerotic metastasis in the right
acetabulum (see follow up images).
The patient is to receive palliative chemotherapy for widely metastatic
osteogenic sarcoma.
View followup image(ct).
AXIAL IMAGE THRU THE LOWER CHEST, BONE WINDOW THRU THE PELVIS, AND CT SCANOGRAM
Differential Diagnosis List
Differential diagnosis for pleural uptake on bone scintigraphy includes
fibrothorax (such as from tuberculosis or trauma), calcified metastases
(e.g. osteogenic sarcoma), pleural effusion, and pleurodesis.
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: bs086
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