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Vertebral metastasis on Indium-111 tagged WBC scanning

Seay TMS - MedPix

View Article: MedPix Image - MedPix Case

Affiliation: Wilford Hall USAF Medical Center

ABSTRACT

Diagnosis: Vertebral metastasis on Indium-111 tagged WBC scanning

History: 74 year old male presenting with persistent low grade fevers. Previous history of cystoprostatectomy and right nephroureterectomy for transitional cell carcinoma of the bladder and right renal collecting system respectively.

Findings: CT scan (without contrast due to renal insufficiency) revealed no evidence of intra-abdominal abscess, however the liver was found to harbor multiple lesions, biopsy of which revealed metastatic transitional cell carcinoma (figure 1). Additonally, a lytic lesion was found of the L2 vertebral body (figure 2). Because of the recurring fevers an Indium-111 tagged WBC study was requested (figures 3 and 4). After reviewing the indium scan results, the primary service relayed that the patient was also complaining of back pain. The differential diagnosis of the findings from the CT and Indium scan included possible discitis/vertebral osteomyelitis, and metastatic disease. Subsequent MR (figure 5) of the lumbar spine demonstrates collapse of the L2 vertebral body, as well as heterogeneous marrow replacement. There was no surrounding fluid component. The discs did not demonstrate involvement with the process. There was marked gadolinium enhancement of the lesions within the vertebral body.

Ddx: Photopenic lesion of the spine with In-111/WBC: osteomyelitis infarction (late) metastasis overlying hardware or bone resection radiation effects myelofibrosis Paget’s disease (lytic phase)

Exam: Examination revealed a chronically ill appearing elderly male. Abdominal exam was negative save evidence of prior surgery to include a ileal conduit stoma in the right lower quadrant. Laboratory evaluation revealed mild leukocytosis. Urine culture revealed Klebsiella pneumoniae.

No MeSH data available.


Noncontrast CT image of upper abdomen reveals multiple hypodensities within the liver, predominantly in the left lateral lobe. Subsequent biopsy revealed metastatic transitional cell carcinoma.
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MPX1660_synpic16987: Noncontrast CT image of upper abdomen reveals multiple hypodensities within the liver, predominantly in the left lateral lobe. Subsequent biopsy revealed metastatic transitional cell carcinoma.


Vertebral metastasis on Indium-111 tagged WBC scanning

Seay TMS - MedPix

Noncontrast CT image of upper abdomen reveals multiple hypodensities within the liver, predominantly in the left lateral lobe. Subsequent biopsy revealed metastatic transitional cell carcinoma.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=MPX1660&req=5

MPX1660_synpic16987: Noncontrast CT image of upper abdomen reveals multiple hypodensities within the liver, predominantly in the left lateral lobe. Subsequent biopsy revealed metastatic transitional cell carcinoma.

View Article: MedPix Image - MedPix Case

Affiliation: Wilford Hall USAF Medical Center

ABSTRACT

Diagnosis: Vertebral metastasis on Indium-111 tagged WBC scanning

History: 74 year old male presenting with persistent low grade fevers. Previous history of cystoprostatectomy and right nephroureterectomy for transitional cell carcinoma of the bladder and right renal collecting system respectively.

Findings: CT scan (without contrast due to renal insufficiency) revealed no evidence of intra-abdominal abscess, however the liver was found to harbor multiple lesions, biopsy of which revealed metastatic transitional cell carcinoma (figure 1). Additonally, a lytic lesion was found of the L2 vertebral body (figure 2). Because of the recurring fevers an Indium-111 tagged WBC study was requested (figures 3 and 4). After reviewing the indium scan results, the primary service relayed that the patient was also complaining of back pain. The differential diagnosis of the findings from the CT and Indium scan included possible discitis/vertebral osteomyelitis, and metastatic disease. Subsequent MR (figure 5) of the lumbar spine demonstrates collapse of the L2 vertebral body, as well as heterogeneous marrow replacement. There was no surrounding fluid component. The discs did not demonstrate involvement with the process. There was marked gadolinium enhancement of the lesions within the vertebral body.

Ddx: Photopenic lesion of the spine with In-111/WBC: osteomyelitis infarction (late) metastasis overlying hardware or bone resection radiation effects myelofibrosis Paget’s disease (lytic phase)

Exam: Examination revealed a chronically ill appearing elderly male. Abdominal exam was negative save evidence of prior surgery to include a ileal conduit stoma in the right lower quadrant. Laboratory evaluation revealed mild leukocytosis. Urine culture revealed Klebsiella pneumoniae.

No MeSH data available.