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Asymmetrically increased rib cage uptake on bone scintigraphy: Incidental detection of pleural mesothelioma on single photon emission computed tomography/computed tomography.

Dhull VS, Sharma P, Durgapal P, Karunanithi S, Tripathi M, Kumar R - Indian J Nucl Med (2014)

Bottom Line: Biopsy confirmed it to be pleural mesothelioma.Left-sided ribs showed no abnormality on CT, thus suggesting the rib uptake as reactive in nature.This pattern of asymmetric rib uptake on BS should be kept in mind and warrants further investigation for determining underlying pathology.

View Article: PubMed Central - PubMed

Affiliation: Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India.

ABSTRACT
Follow-up bone scintigraphy (BS) in a patient of carcinoma left breast, who was treated with surgery followed by radiotherapy 12 years back, revealed asymmetrically increased radiotracer uptake in left-sided ribs. Since, this pattern was atypical for metastatic rib involvement, single photon emission computed tomography/computed tomography (SPECT/CT) of thorax was done in the same setting which revealed circumferential nodular left-sided pleural thickening. Biopsy confirmed it to be pleural mesothelioma. Left-sided ribs showed no abnormality on CT, thus suggesting the rib uptake as reactive in nature. This pattern of asymmetric rib uptake on BS should be kept in mind and warrants further investigation for determining underlying pathology.

No MeSH data available.


Related in: MedlinePlus

99mTc-methylene diphosphonate bone scintigraphy showing diffusely increased left rib cage uptake (anterior a, posterior b; arrows). Transaxial single photon emission computed tomography (SPECT) and SPECT/CT images (c, e; arrows) show diffusely increased radiotracer uptake involving the left-sided ribs. Transaxial CT (bone window, d) shows normal left-sided ribs with regular cortical outlines. Transaxial CT (soft tissue window, f) shows a pleural-based soft tissue density lesion in the left lung lower lobe (f, arrow head) with diffuse circumferential pleural thickening (f, arrow)
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Figure 1: 99mTc-methylene diphosphonate bone scintigraphy showing diffusely increased left rib cage uptake (anterior a, posterior b; arrows). Transaxial single photon emission computed tomography (SPECT) and SPECT/CT images (c, e; arrows) show diffusely increased radiotracer uptake involving the left-sided ribs. Transaxial CT (bone window, d) shows normal left-sided ribs with regular cortical outlines. Transaxial CT (soft tissue window, f) shows a pleural-based soft tissue density lesion in the left lung lower lobe (f, arrow head) with diffuse circumferential pleural thickening (f, arrow)

Mentions: A 50-year-old female patient of carcinoma left breast underwent modified radical mastectomy, followed by radiotherapy 12 years back. She now presented with left-sided chest pain since 3 months. Suspecting the pain to be of musculoskeletal origin, the treating oncologist referred the patient for 99mTc-MDP BS to rule out skeletal metastases. BS was done 3 h, following intravenous injection of 20 mCi of 99mTc-MDP. It revealed diffusely increased radiotracer uptake involving all the left-sided ribs thus giving the appearance of asymmetrically increased left rib cage uptake [Figure 1a and b; arrows]. The remaining skeleton showed normal radiotracer distribution. Because this pattern was atypical for rib metastasis, single photon emission computed tomography/computed tomography (SPECT/CT) of the thorax was done in the same setting. Transaxial SPECT and SPECT/CT images [Figure 1c and e; arrows] revealed diffusely increased radiotracer uptake in all the left-sided ribs. Using bone window on CT [Figure 1d], all the left-sided ribs showed regular cortical outlines with no apparent abnormality. Transaxial CT in soft tissue window revealed circumferential nodular left-sided pleural thickening [Figure 1f; arrow, arrow head]. The increased uptake of tracer in the ribs was likely secondary to the increased vascularity in underlying pleural pathology and was interpreted as reactive in nature. Biopsy from the pleural-based nodular lesion was suggestive of pleural mesothelioma [Figure 2a-d]. Patient was referred to the oncology department for further work up.


Asymmetrically increased rib cage uptake on bone scintigraphy: Incidental detection of pleural mesothelioma on single photon emission computed tomography/computed tomography.

Dhull VS, Sharma P, Durgapal P, Karunanithi S, Tripathi M, Kumar R - Indian J Nucl Med (2014)

99mTc-methylene diphosphonate bone scintigraphy showing diffusely increased left rib cage uptake (anterior a, posterior b; arrows). Transaxial single photon emission computed tomography (SPECT) and SPECT/CT images (c, e; arrows) show diffusely increased radiotracer uptake involving the left-sided ribs. Transaxial CT (bone window, d) shows normal left-sided ribs with regular cortical outlines. Transaxial CT (soft tissue window, f) shows a pleural-based soft tissue density lesion in the left lung lower lobe (f, arrow head) with diffuse circumferential pleural thickening (f, arrow)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3928752&req=5

Figure 1: 99mTc-methylene diphosphonate bone scintigraphy showing diffusely increased left rib cage uptake (anterior a, posterior b; arrows). Transaxial single photon emission computed tomography (SPECT) and SPECT/CT images (c, e; arrows) show diffusely increased radiotracer uptake involving the left-sided ribs. Transaxial CT (bone window, d) shows normal left-sided ribs with regular cortical outlines. Transaxial CT (soft tissue window, f) shows a pleural-based soft tissue density lesion in the left lung lower lobe (f, arrow head) with diffuse circumferential pleural thickening (f, arrow)
Mentions: A 50-year-old female patient of carcinoma left breast underwent modified radical mastectomy, followed by radiotherapy 12 years back. She now presented with left-sided chest pain since 3 months. Suspecting the pain to be of musculoskeletal origin, the treating oncologist referred the patient for 99mTc-MDP BS to rule out skeletal metastases. BS was done 3 h, following intravenous injection of 20 mCi of 99mTc-MDP. It revealed diffusely increased radiotracer uptake involving all the left-sided ribs thus giving the appearance of asymmetrically increased left rib cage uptake [Figure 1a and b; arrows]. The remaining skeleton showed normal radiotracer distribution. Because this pattern was atypical for rib metastasis, single photon emission computed tomography/computed tomography (SPECT/CT) of the thorax was done in the same setting. Transaxial SPECT and SPECT/CT images [Figure 1c and e; arrows] revealed diffusely increased radiotracer uptake in all the left-sided ribs. Using bone window on CT [Figure 1d], all the left-sided ribs showed regular cortical outlines with no apparent abnormality. Transaxial CT in soft tissue window revealed circumferential nodular left-sided pleural thickening [Figure 1f; arrow, arrow head]. The increased uptake of tracer in the ribs was likely secondary to the increased vascularity in underlying pleural pathology and was interpreted as reactive in nature. Biopsy from the pleural-based nodular lesion was suggestive of pleural mesothelioma [Figure 2a-d]. Patient was referred to the oncology department for further work up.

Bottom Line: Biopsy confirmed it to be pleural mesothelioma.Left-sided ribs showed no abnormality on CT, thus suggesting the rib uptake as reactive in nature.This pattern of asymmetric rib uptake on BS should be kept in mind and warrants further investigation for determining underlying pathology.

View Article: PubMed Central - PubMed

Affiliation: Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India.

ABSTRACT
Follow-up bone scintigraphy (BS) in a patient of carcinoma left breast, who was treated with surgery followed by radiotherapy 12 years back, revealed asymmetrically increased radiotracer uptake in left-sided ribs. Since, this pattern was atypical for metastatic rib involvement, single photon emission computed tomography/computed tomography (SPECT/CT) of thorax was done in the same setting which revealed circumferential nodular left-sided pleural thickening. Biopsy confirmed it to be pleural mesothelioma. Left-sided ribs showed no abnormality on CT, thus suggesting the rib uptake as reactive in nature. This pattern of asymmetric rib uptake on BS should be kept in mind and warrants further investigation for determining underlying pathology.

No MeSH data available.


Related in: MedlinePlus