Myelofibrosis presenting as hypermetabolic bone disease by radionuclide imaging in a patient with asplenia

In a patient with myelocytic anemia, hepatomegaly, and metastases suggested by radiographic evidence of sclerosis throughout the pelvis and spine, a liver-spleen scan revealed mild hepatomegaly and an absent splenic image. A bone scan demonstrated diffusely increased activity in all bones, especially in the joint regions. A bone marrow scan showed only hepatic activity but no significant uptake in the bone marrow. Ultrasonography and contrast angiography failed to identify a spleen. The findings from a bone marrow biopsy and a peripheral blood examination indicated myelofibrosis. The implications of an increased concentration of radiopharmaceuticals in bone are briefly discussed.