Unusual appearance for urinary bladder obstruction detected with 99mTc-MDP bone scintigraphy

Area of Science:

• Nuclear Medicine
• Diagnostic Imaging
• Urology

Background:

• Bone scintigraphy is a crucial nuclear medicine imaging technique for detecting bone metastases and other skeletal abnormalities.
• Nonosseous findings, though incidental, can provide critical diagnostic information.
• This case highlights the potential for bone scintigraphy to reveal unexpected urinary tract pathology.

Observation:

• An 83-year-old male patient with a pathologic femur fracture underwent whole-body bone scintigraphy.
• Intense radiotracer accumulation was observed in the kidneys and ureters, with no activity in the urinary bladder.
• The patient had a 14-hour voiding interval, suggesting potential urinary retention.

Findings:

• A Foley catheter was inserted, draining over 2000 mL of urine, confirming urinary bladder obstruction.
• Repeat bone scintigraphy post-catheterization showed a significant decrease in renal and ureteral radiotracer activity.
• Trace activity was noted in the urinary bladder after decompression.

Implications:

• Bone scintigraphy can serve as an indirect diagnostic tool for urinary bladder outlet obstruction.
• Prompt recognition of such nonosseous findings can prevent delayed diagnosis and management of urologic emergencies.
• This case underscores the importance of correlating imaging findings with clinical context, including patient voiding status.