Technetium-99m methylene diphosphonate uptake in the brachialis muscle hematoma in a patient with prostate cancer and coagulation disorder mimicking bone metastasis evaluated by single-photon emission tomography-computed tomography/computed tomography

Abstract

We report a case of 79-year-old male with prostate cancer and coagulation disorder presented with left shoulder pain. He underwent bone scintigraphy to rule out metastasis, which showed intense foci of tracer activity in the left axilla. Hybrid single-photon emission tomography-computed tomography (SPECT/CT) of the shoulder region localized tracer uptake to the left brachialis muscle hematoma.

Extraosseous Findings on Bone Scintigraphy Using Fusion SPECT/CT and Correlative Imaging

“…A number of publications have reported dramatic muscular radiopharmaceutical uptake in patients with a recent history of strenuous exercise, such as intense uptake in the bilateral pectoral muscles of a man who reported doing strenuous exercise a few days before, which was attributed to increased vascularity, extracellular fluid, and tissue calcium concentration related to his recent workout [26]. Similar findings have been described in the rectus abdominis muscles in a patient after doing sit-up exercises [27], as well as in lower extremity muscles in a long-distance runner [28] and in association with muscle hematoma [29,30]. In addition to exercise, other forms of injury and inflammation may increase soft-tissue uptake on bone scintigraphy, including electrical injuries [31], dermatomyositis, and polymyositis [32].…”

“…Kidneys, ureter, and bladder Renal cell cancer [3], malignant hypercalcemia [4], pyelonephritis [4], ureteric hold-up [8], renal stones a [7,8,35], medications (iron, dextrose, chemotherapy, amphotericin B) [4], hydronephrosis [4], ileal conduit and stomal bag a Colon Vesicocolonic fistula, active gastrointestinal bleeding, inflammatory or infective colitis, prior sestamibi imaging [6], urine ingestion, colorectal or gastrointestinal stromal tumor [24] Small bowel Primary intestinal lymphangiectasia, protein-losing enteropathy [6] Ovaries Benign and malignant ovarian neoplasms [6] Uterus Fibroid uterus [6] Others Inguinal lymph node metastasis a [8], migration of extravasated radiotracer from injection in the foot Extremities and skin Skin Skin contamination, subcutaneous or intramuscular injections [7], surgical scars Arms Intraarterial injections [3], extravasated radiotracer at the cubital fossa injection site [6], osteosarcoma a Legs Heterotopic ossification a [4,8,9,[55][56][57], thigh abscess [7], osteosarcoma a [8], rhabdomyosarcoma [7,23], synovial sarcoma [4], intraarterial injections [3], arterial calcifications, varicose veins [7], acute muscle infarction, myonecrosis and calcification a [4,[26][27][28][29][30], deep vein thrombosis [6,7], lymphoedema …”

Comparison of the diagnostic accuracy of 99 m-Tc-MDP bone scintigraphy and 18 F-FDG PET/CT for the detection of skeletal metastases

“…Currently, SPECT and SPECT/CT are not routinely performed for skeletal metastases. FDG PET/CT has the benefit of detecting metastases in other organ systems, but SPECT and SPECT/CT allow for the use of a greater variety of different radionuclides (22)(23)(24)(25)(26)(27)(28)(29)(30)(31).…”

Hybrid Single-Photon Emission Computed Tomography/Computed Tomography Imaging Features of Tumoral Calcinosis in Technetium-99m Methylene Diphosphonate Bone Scintigraphy

“…[ 3 8 ] Proposed mechanism leading to increased extraosseous Tc-99m MDP uptake include extracellular fluid expansion, enhanced regional vascularity and permeability, diminished lymphatic or venous removal from the affected area, and elevated tissue calcium concentration. [ 9 ] Because of the advent of SPECT/CT, it is possible to localize exact site of tracer uptake and characterize the lesion to guide further management. [ 10 ] Our case is the first case of SPECT/CT demonstrating TC.…”