Diffuse and intense Tc-99m HMDP localization in the liver due to hypoxia secondary to respiratory failure

After left lower lobe lobectomy for lung carcinoma, a patient had acute respiratory failure secondary to pneumonia and pulmonary embolism requiring a ventilator. Tc-99m HMDP bone scan showed diffuse, intense hepatic uptake. Concurrent liver enzymes indicated hepatic necrosis. Two weeks later the patient died and a limited chest autopsy confirmed acute adult onset respiratory distress syndrome. Etiologic factors of massive hepatic necrosis in relation to hepatic localization of bone imaging agent and its prognostic outcome are discussed.