An uncommon case showing three different pathologies on (99m)technetium-methylene diphosphonate bone scintigraphy

Area of Science:

• Nuclear Medicine
• Radiology
• Oncology

Background:

• (99m)Technetium-methylene diphosphonate bone scintigraphy (BS) is crucial for assessing skeletal pathology extent.
• Extra-osseous uptake on BS can indicate soft-tissue pathologies.
• Multifocal findings on a single BS scan, especially with diverse etiologies, are uncommon.

Purpose of the Study:

• To present a unique case of (99m)Technetium-methylene diphosphonate bone scintigraphy (BS).
• To illustrate the detection of multiple, distinct pathologies in a single scan.
• To emphasize the diagnostic utility of BS in complex clinical scenarios.

Main Methods:

• A 64-year-old female patient underwent (99m)Technetium-methylene diphosphonate bone scintigraphy (BS).
• The patient presented with skull base osteomyelitis and had a history of Pott's spine.
• Imaging analysis focused on identifying osseous and extra-osseous uptake patterns.

Main Results:

• BS confirmed left-sided skull base osteomyelitis.
• Incidental bilateral lung uptake was observed, attributed to hypercalcemia associated with renal failure.
• D12-L1 vertebral uptake indicated a flare of Pott's spine.

Conclusions:

• This case demonstrates the capacity of (99m)Technetium-methylene diphosphonate bone scintigraphy (BS) to identify diverse pathologies simultaneously.
• The findings underscore the importance of considering multiple etiologies for unexpected uptake on BS.
• This unique presentation highlights the comprehensive diagnostic value of BS in evaluating complex patient cases.