pyrophosphate and Rhabdomyolysis

Six patients with soft tissue injury secondary to different etiologic factors are presented. The degree and extent of tissue necrosis was precisely identified by scintigraphy. In two of these, radionuclide imaging helped to establish accurately the level of amputation that resulted in appropriate wound healing.

Topics: Adult; Burns, Electric; Child Abuse; Child, Preschool; Diabetic Neuropathies; Diphosphates; Humans; Male; Radionuclide Imaging; Rhabdomyolysis; Technetium; Technetium Tc 99m Medronate; Technetium Tc 99m Pyrophosphate

Topics: Aged; Bone and Bones; Diphosphates; Heart; Humans; Male; Radionuclide Imaging; Rhabdomyolysis; Technetium; Technetium Tc 99m Pyrophosphate

We performed bone scans with 99mTechnetium phosphates in 15 cases of clinically suspected rhabdomyolysis admitted to Chigasaki Tokushukai Hospital. Whole body scans were performed within 5 days from the onset of illness or admission. Accumulation of the radioactivity in the skeletal muscle was revealed in 13 of the 15 cases and the involved muscle groups were visualized vividly. Etiologies of rhabdomyolysis were diverse, ranging from malignant syndrome to sepsis. Myocardial concentration was absent in all of the cases. Renal concentration of the isotope was seen in cases where the degree of rhabdomyolysis was higher and renal impairment was present. We conclude that 99mTechnetium phosphate bone scan is useful in clinically suspected rhabdomyolysis as a diagnostic test and as a test to localize and quantitate the muscular involvement.

Topics: Adult; Aged; Aged, 80 and over; Diphosphates; Female; Humans; Male; Middle Aged; Radionuclide Imaging; Rhabdomyolysis; Technetium; Technetium Tc 99m Medronate; Technetium Tc 99m Pyrophosphate

Four sequential Tc-99m pyrophosphate (PYP) imaging studies were performed in a 28-year-old man with high fever and exudate pharyngitis associated with renal failure. Radiotracer localization in the left ventricle (LV), lungs, kidneys, and skeletal muscles were seen in two, initial imaging studies. In the second and third imaging studies, area of increase in activity was seen in the left-sided bowel. In studies done two months later (in the third study), the radioactivity in the skeletal muscles was no longer seen. Studies obtained nine months (in the fourth study) after the first imaging showed less radiotracer localization in the LV, lungs, and kidneys as compared to that seen in the initial study. Myocardial necrosis and microcalcification were proved by LV biopsy. The exact mechanism of extraosseous bone-imaging agent localization is unknown. However, this phenomenon may be related to renal failure, rhabdomyolysis, hypercalcemia, hyperphosphatemia, or elevated parathyroid hormone. The Tc-99m PYP imaging study is useful and sensitive in the detection of extraosseous tissue calcification and monitoring of the disease process.

Topics: Acute Kidney Injury; Adult; Diphosphates; Humans; Hypercalcemia; Male; Phosphates; Radionuclide Imaging; Rhabdomyolysis; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Adult; Antibodies, Monoclonal; Diphosphates; Female; Humans; Immunoglobulin Fab Fragments; Indium Radioisotopes; Myosins; Radionuclide Imaging; Rhabdomyolysis; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Adult; Arterial Occlusive Diseases; Diphosphates; Humans; Ischemia; Leg; Male; Middle Aged; Radioisotopes; Radionuclide Imaging; Rhabdomyolysis; Technetium; Technetium Tc 99m Pyrophosphate; Thallium

Patients with rhabdomyolysis (RBD) and acute renal failure (ARF) are hypocalcemic during the oliguric phase of ARF and over 30% develop hypercalcemia during the diuretic phase. The present study examined the factors underlying these derangements in calcium metabolism in 15 patients: 7 with RBD and ARF, 4 with RBD only, and 4 with ARF only. All patients had hypocalcemia on admission and the hypocalcemia was more pronounced in those with RBD and ARF. All patients with RBD independent of the presence or absence of ARF had calcium deposition in soft tissues as documented by technetium-99 scan. In 4 patients with RBD and ARF, hypercalcemia developed during the diuretic phase at a time when Serum PTH levels were undetectable. Only patients with RBD and ARF had a significant increase in serum levels of 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D [1,25(OH)2D] during the diuretic phase and both the increments in and the levels of 1,25(OH)2D were significantly greater in those who were hypercalcemic. The data indicate that 1) hypocalcemia occurs in RBD independent of ARF and is most likely related to calcium deposition in injured tissues, and 2) elevation in serum levels of 1,25(OH)2D plays an important role in the genesis of hypercalcemia during the diuretic phase of patients with RBD and ARF. Our observations suggest that extrarenal production of 1,25(OH)2D may occur in these patients, and/or that the renal production of 1,25(OH)2D may not be so tightly controlled as it is in normal subjects.

Topics: Acute Kidney Injury; Adult; Calcinosis; Calcitriol; Diphosphates; Diuresis; Female; Humans; Hypercalcemia; Hypocalcemia; Male; Middle Aged; Parathyroid Hormone; Radionuclide Imaging; Rhabdomyolysis; Technetium; Technetium Tc 99m Pyrophosphate; Time Factors

Technetium-99m pyrophosphate (Tc-PYP) imaging was performed in five patients with acute renal failure associated with nontraumatic rhabdomyolysis. Four patients had phencyclidine intoxication and one had viral pneumonia. During the acute phase, marked uptake of pyrophosphate was seen in all patients in several muscle groups, but always in the thigh adductors. The results show that phencyclidine intoxication can result in diffuse muscle uptake of Tc-PYP without overt evidence of muscle injury. Tc-PYP imaging may provide a clue to the cause of acute renal failure in patients with suspected rhabdomyolysis in whom elevations of serum creatine phosphokinase concentrations are equivocal.

Topics: Acute Kidney Injury; Adult; Diphosphates; Humans; Male; Radionuclide Imaging; Rhabdomyolysis; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Adult; Diphosphates; Humans; Male; Muscles; Radionuclide Imaging; Rhabdomyolysis; Technetium; Technetium Tc 99m Pyrophosphate