technetium-tc-99m-medronate and Adenoma

Metastatic pulmonary calcification (MPC) is rarely reported in primary hyperparathyroidism, especially MPC develops quickly. We report such a case here with a literature review.. A 41-year-old woman presented with cough and dyspnea. Data from clinical, radiological, pathological, technetium (. Rapidly progressive MPC tends to be misdiagnosed as many primary pulmonary diseases.

Topics: Adenoma; Adult; Calcinosis; Disease Progression; Female; Humans; Hyperparathyroidism, Primary; Image-Guided Biopsy; Lung Diseases; Parathyroid Neoplasms; Parathyroidectomy; Positron-Emission Tomography; Radiopharmaceuticals; Technetium Tc 99m Medronate; Technetium Tc 99m Sestamibi; Tomography, X-Ray Computed; Treatment Outcome

Over the past 5 years, we have encountered 6 cases of diffuse pulmonary uptake of 99m-Tc bone-scanning agents (incidence, 0.04%). To assess the significance of this phenomenon, we reviewed all of the cases reported since 1974 (Including our series, a total of 32 cases). Three groups can be discerned, the first consisting of 24 patients without radiological calcifications in the lungs and with hypercalcemia of different origins (mostly hyperparathyroidism). Of the eight autopsies performed in this group, seven revealed extensive calcifications in alveolar walls and lung vessels; the other autopsy showed no calcification at all and only bronchopneumonic lesions. The second group consists of 6 patients in chronic dialysis. The last group consists of 2 patients having diffuse pulmonary alveolar microlithiasis with extensive radiologic calcifications. The mechanism of lung uptake of 99m-Tc bone-imaging agents is probably the same as that of bone uptake (chemisorption on hydroxyapatite crystals), although other uptake mechanisms have also been discussed. Bone scintigraphy can be useful in the detection of early pulmonary calcifications, which have been associated with impaired pulmonary function and, due to their size, are generally not detected by X-ray.

Topics: Adenoma; Adult; Aged; Bone Diseases; Calcinosis; Female; Humans; Hypercalcemia; Lung Diseases; Male; Middle Aged; Multiple Myeloma; Parathyroid Neoplasms; Radionuclide Imaging; Technetium Tc 99m Medronate; Vitamin D

Paget disease of bone (PDB) and hyperparathyroidism (HPT) are metabolic osseous disorders which affect ≥2% of the population. As these diseases may share clinical, radiographic, biochemical, and histopathologic features, knowledge of their phenotypic overlap may provide diagnostic utility and improve clinical outcome. Scant information is available in the dental literature regarding patients concurrently affected with both pathologies. We present an unusual case report of a 63-year-old woman coaffected with primary HPT, attributed to a functional oxyphilic parathyroid adenoma, and PDB. Bone scintigraphy revealed pagetoid lesions of the skull, humeral head, spine, sacrum, and hemipelvis. Salient craniofacial features noted were bony involvement of the calvarium and midface, resulting in extensive maxillary overgrowth, hearing loss, telecanthus and consequent visual impairment, nasal deformity, and leontiasis ossea. The patient underwent a partial parathyroidectomy and bisphosphonate administration was to be initiated upon extraction of the remaining dentition.

Topics: Adenoma; Female; Humans; Hyperostosis; Hyperostosis Frontalis Interna; Hyperparathyroidism, Primary; Hypertelorism; Maxillary Diseases; Middle Aged; Nose Deformities, Acquired; Osteitis Deformans; Parathyroid Neoplasms; Parathyroidectomy; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

Acute-onset primary hyperparathyroidism in a previously asymptomatic individual is uncommon. We herein report the case of a 61-yr old woman who underwent bone scintigraphy for severe, rapidly worsening, diffuse bone pain, associated with weight loss, anxiety and confusion. The patient was asymptomatic until a few days before presentation. A marked redistribution of the tracer was observed, with poor bone uptake and relevant accumulation in liver, kidneys, lungs and spleen. Blood chemistry unequivocally allowed the diagnosis of primary hyperparathyroidism due to multiple parathyroid adenomas, as suggested by parathyroid scan. Unfortunately, the patient critically worsened and surgery was made impossible. She died despite intensive critical care. Autopsy confirmed both massive intraparenchymal calcium deposition in the kidneys, lungs, liver and spleen, as well as multiple parathyroid adenomas. One may speculate that some adaptation of the organism to progressively increasing blood calcium levels and to slowly increasing intraparenchymal calcium salt deposition occurred, until critically high concentrations were attained.

Topics: Adenoma; Bone and Bones; Fatal Outcome; Female; Humans; Hyperparathyroidism; Middle Aged; Pain; Parathyroid Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Severity of Illness Index; Technetium Tc 99m Medronate

Topics: Adenoma; Bone and Bones; Humans; Male; Middle Aged; Parathyroid Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

The authors present the case of a patient with recurrent hyperparathyroidism who was shown on thallium-technetium subtraction scintigraphy, ultrasound, and magnetic resonance imaging to have recurrent parathyroid tissue in the right side of the neck. The thallium scan also showed intense uptake centrally in the chest, mimicking an intrathoracic adenoma. This was subsequently shown on plain films and a radionuclide bone scan to be due to Paget's disease of the sternum. This case illustrates the value of a combined imaging strategy in preventing an unnecessary thoracotomy after a false-positive nuclear medicine scan.

Topics: Adenoma; Aged; Choristoma; Diagnosis, Differential; Female; Humans; Hyperparathyroidism; Magnetic Resonance Imaging; Neck; Osteitis Deformans; Parathyroid Glands; Parathyroid Neoplasms; Radiopharmaceuticals; Recurrence; Sternum; Subtraction Technique; Technetium Tc 99m Medronate; Thallium Radioisotopes; Thoracic Diseases; Tomography, Emission-Computed, Single-Photon; Ultrasonography

Metastatic calcification within soft tissue, such as the lung and stomach, is associated with hyperparathyroidism, chronic renal failure, hemodialysis, metastatic neoplasm and hypervitaminosis D. Bone scanning agents variably accumulate within these extraskeletal metastatic calcifications. We report a patient with primary hyperparathyroidism whose bone scan revealed abnormal uptake in the liver, lung, stomach and parathyroid gland followed by complete resolution of extraskeletal uptake less than 1 wk after parathyroidectomy.

Topics: Adenoma; Aged; Bone and Bones; Calcinosis; Female; Humans; Hypercalcemia; Hyperparathyroidism; Parathyroid Neoplasms; Parathyroidectomy; Radionuclide Imaging; Technetium Tc 99m Medronate

Topics: Adenoma; Adult; Bone Neoplasms; Diagnosis, Differential; Female; Humans; Hyperparathyroidism; Osteitis Fibrosa Cystica; Parathyroid Neoplasms; Radiography; Radionuclide Imaging; Technetium Tc 99m Medronate

Two cases of prostatic cancer with single bone metastasis in the tibia are discussed. The intense uniform involvement of a solitary limb bone with high perfusion and blood pool activity in the 3-phase bone scan and the positive white blood cell scan (observed in one case) were not typical for a metastatic bone lesion. Conventional radiomorphology--lamellar, periosteal reaction, disseminated medullar sclerosis, no localized lesion--also led to other differential considerations such as osteomyelitis and malignant lymphoma, which could not be specified by CT and MRI. Even if there is no typical morphology in scintigraphic and radiologic imaging, biopsy should be performed to exclude bone metastasis in prostatic cancer.

Topics: Adenoma; Aged; Bone Neoplasms; Humans; Magnetic Resonance Imaging; Male; Prostatic Neoplasms; Radionuclide Imaging; Technetium Tc 99m Medronate; Tibia; Tomography, X-Ray Computed

It is generally agreed that the Technetium-Thallium Subtraction Scan is a reliable method for locating abnormal parathyroid glands in patients with clinical and biochemical evidence of parathyroid hyperactivity. This report illustrates the value of scintigraphy in diagnosis and in the subsequent surgical management of a patient with primary hyperparathyroidism.

Topics: Adenoma; Adult; Bone and Bones; Female; Humans; Hyperparathyroidism; Parathyroid Neoplasms; Radioisotopes; Radionuclide Imaging; Subtraction Technique; Technetium Tc 99m Medronate; Thallium

Topics: Adenoma; Diphosphonates; Female; Humans; Middle Aged; Parathyroid Neoplasms; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Topics: Adenoma; Bone and Bones; Diphosphonates; Humans; Male; Middle Aged; Parathyroid Neoplasms; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Topics: Adenoma; Adult; Aged; Bone and Bones; Bone Neoplasms; Carcinoma, Small Cell; Carcinoma, Squamous Cell; Diphosphonates; Female; Humans; Lung Neoplasms; Male; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Intense diffuse uptake of Tc-99m-labeled methylene diphosphonate was seen in both lungs of a patient submitted to surgery for a primary parathyroid adenoma. Five scans performed over the 3 yr following the operation showed persistence of lung uptake despite restoration of normal blood calcium concentration. Mild chronic renal failure caused by the hypercalcemia also persisted postoperatively. The present case confirms that pulmonary uptake of bone tracer can occur asymptomatically when both hypercalcemia and renal failure are present. Lung uptake of a bone tracer probably reflects tissue deposition of hydroxyapatite rather than of amorphous structures. Correction of the hypercalcemia failed to resolve the abnormal scan pictures.

Topics: Adenoma; Bone and Bones; Diphosphonates; Female; Humans; Hypercalcemia; Kidney Failure, Chronic; Lung; Middle Aged; Parathyroid Neoplasms; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate