Progression of Multiple Myeloma Detected on Cardiac Scintigraphy with 99mTc Sestamibi

It is important to understand normal and abnormal radiotracer biodistribution patterns in patients who undergo cardiac Tc-2-methoxyisobutyl-isonitrile (Tc-sestamibi) scans to provide important clinical guidance. Our case describes a 75-year-old man with a history of multiple myeloma in remission, who presented to the emergency department for unrelated chest pain and shortness of breath. The patient underwent a nuclear cardiac stress test with Tc-sestamibi scintigraphy as part of his cardiac workup. The images demonstrated diffuse radiotracer uptake in the skeletal structures raising concern for progression of multiple myeloma, of which, subsequent biopsy confirmed the presence of recurrent disease.