Anterior and posterior views of the abdomen and chest are shown.
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View second image(xr). Anterior-posterior and lateral views of the thoracic spine.
Full history/Diagnosis is available below
Plasma Phosphorus: 5.8 mg/dl (nl: 2.3 - 4.3 mg/dl)
Serum Calcium: 7.8 mg/dl (nl: 8.6 - 10.3 mg/dl)
Blood Urea Nitrogen: 52 mg/dl (nl: 8 - 25 mg/dl)
Serum Creatine: 2.1 mg/dL (nl: 0.6 - 1.4 mg/dl)
She is taking prevacid 30 mg qd.
There is mild uptake in T6 and moderate uptake in T8 consistent with subacute compression fractures. Mild uptake right lower rib is likely due to trauma.
Thoracic spine radiographs: There are vertebroplasties at T10, T11 and T12. Compression deformities at T6, T8 and L1 are noted, unchanged from comparison study 1 month prior (images not shown). There is atherosclerotic disease of the aorta.
Soft tissue calcification is another cause of soft tissue uptake of Tc99m MDP. Tracer may also bind in necrotic tissues (e.g. myositis or myonecrosis).
Causes of "metastatic calcification" include hypercalcemia from widespread destruction of bone (from metastatic cancer), chronic renal disease, primary parathyroid neoplasm and hypervitaminosis D. When the solubility product for calcium and phosphate is exceeded, there is precipitation of calcium in the extracellular space.
Acid secreting organs and organs in which there are rapid pH changes(i.e. the stomach, kidneys and lungs) can cause precipitation of calcium salts. This is well demonstrated in this case. Note however the absence of gastric uptake. This absence is presumed due to alterations in pH because the patient has been taking the H2 blocker, Prevacid. Myocardial calcification can also occur, which can be clinically significant especially when involving the cardiac conducting system.
REFERENCES: Williams, SC (2001) Nuclear Medicine Online Reference Text. Bone Imaging: Soft Tissue Abnormalities. Retrieved April 26, 2004, from Aunt Minnie Web Site: http://www.auntminnie.com/
Recent bone densitometry demonstrated lumbar spine osteopenia, and osteoporosis in the hip.
For companion case see case #BS113
References and General Discussion of Bone Scintigraphy (Anatomic field:Skeletal System, Category:Metabolic, endocrine, toxic)
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