Tc-99m methylene diphosphonate (MDP) bone scintigraphy has long been used for the evaluation of benign as well as malignant skeletal conditions. However, non-osseous tracer uptake on a bone scan is an unusual finding. On one hand, there is a need for awareness of the pathophysiologic basis underlying such uptake, as it may be of critical clinical relevance in the evaluation of the patient. On the other hand, some alterations in biodistribution may be of little clinical significance, but have deleterious consequences on the quality of the bone study. Recognition of these abnormalities will reduce errors and provide important clinical information. We described a case of 57-year-old male patient with history of carcinoma base of tongue, where a 99mTc-MDP bone Scintigraphy was performed for metastasis survey. It revealed avascular necrosis of head of right femur. In addition incidentally demonstrated diffuse increased pathologic uptake of Tc-99m-MDP in the liver and multiple foci in bilateral lungs. This article reviews several possible reasons for such diffuse hepatic uptake. In the present case diffuse hepatic necrosis secondary to respiratory failure due to bilateral miliary pulmonary metastasis is considered to be the cause of the diffuse liver uptake of 99mTc-MDP.

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