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Case #1
This is a sixty five-year-old male who was reported to have carcinoma of the prostate in a recent biopsy specimen. This bone scan was done to survey the entire skeleton for possible metastases. At the time of the scan, there was no clinical information which would suggest that he had metastatic involvement.
The images showed an interesting distribution of the radiopharmaceutical. There was some extravasation at the injection site (right forearm) but in addition to the skeleton, the patient’s right shoe was clearly imaged. What is the explanation for this phenomenon?
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Case #2
This patient was originally treated with a total joint replacement for severe osteoarthritis of the right knee. Ten (10) days after the surgery he developed a severe inflammatory process involving the soft tissues of the knee at the operative site and this apparently progressed to thrombophlebitis. During a follow up clinic visit several days after discharge from the hospital, the patient experienced the sudden onset of chest pain and shortness of breath.
Clinically, it was thought the patient had developed pulmonary embolization. A chest radiograph was obtained and that was followed by a ventilation and perfusion lung scan. The radiopharmaceutical was injected through the patient's IV which had been put in place in the clinic. The chest radiograph and the perfusion scan are shown below.
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The perfusion lung scan showed an interesting distribution of radioactivity. Several focal areas of intense radioactivity were noted scattered throughout the lung fields. The question about this study is, what caused these focal accumulations of radioactivity? Another important question that should be asked is, how large are the abnormalities which result in increased localization of radioactivity?
Send your answer to: Dr. David Adcock, david@gw.med.sc.edu
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This page was last updated 17 August 2000.
