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Dialysis-related amyloidosis mimicking metastatic bone disease: a scintigraphic pitfall of non-MDP-avid osteolytic
Tzyy-Ling Chuang1,2, Chih-En Tseng3,4, Po-Hsun Lin5
1Department of Nuclear Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan. b8601139@tmu.edu.tw.
Background:
Dialysis-related amyloidosis (DRA) is a recognized complication of long-term dialysis caused by progressive deposition of β2-microglobulin amyloid in osteoarticular and periarticular tissues. Although its musculoskeletal manifestations are well described, bone lesions from DRA may be misidentified as malignant disease on imaging, posing a diagnostic challenge.
Case Presentation:
We describe a 70-year-old woman on long-term dialysis who presented with a pathologic femoral neck fracture and adjacent osteolytic lesions initially suspicious for metastatic disease or brown tumor. Bone SPECT/CT showed uptake only at the fracture site with background activity in the lytic lesions. Histopathological examination confirmed the diagnosis of amyloidosis by Congo red staining.
Conclusions:
This case illustrates that DRA may present as non-MDP-avid osteolytic lesions on bone scintigraphy, potentially mimicking malignant bone disease. Awareness of this scintigraphic pitfall is essential when evaluating dialysis patients with atypical skeletal lesions.
Insights
Dialysis-related amyloidosis (DRA) can cause bone lesions that mimic cancer on imaging. This case highlights that these lesions may not show up on bone scans, posing a diagnostic challenge for physicians.
Area of Science:
- Nephrology
- Orthopedics
- Radiology
- Pathology
Background:
- Dialysis-related amyloidosis (DRA) is a complication of long-term dialysis.
- It involves beta-2 microglobulin amyloid deposition in tissues.
- DRA bone lesions can be mistaken for malignant disease on imaging.
Purpose of the Study:
- To present a case of atypical bone lesions in dialysis-related amyloidosis.
- To highlight the diagnostic challenges posed by these lesions on imaging.
- To emphasize the importance of recognizing this scintigraphic pitfall.
Main Methods:
- Case report of a 70-year-old woman on long-term dialysis.
- Presentation with a femoral neck fracture and osteolytic lesions.
- Evaluation with bone SPECT/CT and histopathological examination.
Main Results:
- Bone SPECT/CT showed uptake only at the fracture site, with background activity in lytic lesions.
- Histopathology confirmed amyloidosis via Congo red staining.
- The osteolytic lesions were non-MDP-avid.
Conclusions:
- DRA can present as non-MDP-avid osteolytic lesions on bone scintigraphy.
- These lesions can mimic malignant bone disease.
- Awareness is crucial for diagnosing dialysis patients with skeletal lesions.
