Any cause of hypercalcemia, most commonly primary or secondary hyperparathyroidism , can cause metastatic calcifications and abnormal pulmonary uptake. Metastatic osteosarcoma, neuroblastoma , radiation pneumonitis, and rarely bronchogenic carcinoma may demonstrate increased uptake of bone tracers. Accumulation of Tc-99m diphosphonate is also seen in pleural effusions, usually malignant.
CHEST UPTAKE
- Alveolar microlitiasis 1,2,3,4
- Artefact
- Aspergillosis
- Berylliosis
- Fibrothorax
- Hyperparathyroidism
- Hypercalcemia (ref) 8
- Hypervitaminosis D
- Idiopatic pulmonary ossification
- Infection (ref)9,10
- Liver transplant
- Lung carcinoma 11,12,13
- Metastases 14
- Mitral stenosis
- Neuroblastoma (ref)
- Pleural effusion (ref)
- Radiation therapy
- Sarcoidosis
- Tuberculosis
Primary hyperparathyroidism
The scintigrams (posterior (A) and anterior (B) projections) shows diffuse increased radionuclide uptake in the lungs and stomach, that represents metastatic calcifications, in a patient with parathyroid adenoma.
Osteosarcoma with pulmonary metastases
This bone scintigram in posterior projection demonstrates foci of abnormally increased radiotracer activity in the left hemithorax, in a patient with known osteosarcoma.
Neuroblastoma
This scintigram shows intense uptake in the mediastinum. Thirty-five to 74% of primary neuroblastomas accumulate bone agents, presumably secondary to dystrophic calcifications in the tumor.
Malignant pleural effusion
The bone scintigram (A) shows diffuse accumulation of the radiotracer in a malignant pleural effusion within the right hemithorax of this patient with lung carcinoma. A CT scan (B) confirms the presence of a right-sided pleural effusion.
Malignant pleural effusion
Anterior (A) and posterior (B) bone scintigrams show generalized increased radionuclide accumulation in the left hemithorax in this patient with lung carcinoma. A chest X-ray (C) confirms the presence of a left-sided pleural effusion.
Seminoma
(A) The bone scintigram in anterior projection demonstrates abnormally increased radionuclide activity in the mediastinum. There is a bulky soft tissue mass occupying the mediastinum on this axial CT (B) of the chest, that displaces the thoracic aorta posteriorly. The mediatinal mass is biopsy-proven seminoma.
Urine Contamination
(A) Initial bone scintigram in anterior projection shows several ill-defined areas of radiotracer accumulation that subsequently disappears on repeat scan (B) following decontamination.
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