technetium-tc-99m-medronate and Fat-Necrosis

Pancreatic disease can be associated with polyarthritis and panniculitis in a small number of patients, and this triad constitutes PPP syndrome. Early diagnosis is critical as it has high morbidity and mortality. Panniculitis can occur in fat present anywhere in the body. Involvement of fat in bone marrow is relatively uncommon, and radiologic imaging shows osteolytic lesions involving long bones. Here we present a case of acute pancreatitis, referred to our department for evaluation of severe joint pain and multiple bone pain. Tc-MDP scan with SPECT/CT has been done, which showed medullary expansion with heterogenous tracer uptake, that is, moth-eaten appearance.

Topics: Acute Disease; Bone and Bones; Fat Necrosis; Humans; Male; Pain; Pancreatitis; Single Photon Emission Computed Tomography Computed Tomography; Technetium Tc 99m Medronate

We describe findings of intramedullary fat necrosis on five imaging studies in a patient with alcoholic pancreatitis. Radiography and CT of extremities showed multiple osteolytic lesions that were initially considered to be metastases. However, a 99mTc-methylene diphosphonate whole-body bone scan revealed abnormal areas of increased uptake in only the bones of extremities without involvement of the axial skeleton, a distribution quite unusual for metastatic disease. Furthermore, 99mTc-sestamibi scintigraphy was essentially normal. MRI revealed findings compatible with the diagnosis of fat necrosis/infarct. Findings from bone biopsy demonstrated necrotic bone marrow without malignant cells. It may not be necessary to perform all the imaging studies described in this report when clinical features suggesting metastatic fat necrosis are present. Appearance and distribution of abnormalities on the whole-body bone scan and MR images show that necrosis/infarct of the marrow may obviate bone biopsy, which is often needed to confirm the diagnosis of intramedullary fat necrosis and to exclude neoplastic processes.

Topics: Aged; Bone and Bones; Fat Necrosis; Humans; Male; Pancreatitis, Alcoholic; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Technetium Tc 99m Sestamibi

Pancreatic inflammation and tumors can induce various systemic lesions of steatonecrosis. We report here the case of a 73-year-old woman presenting a painful left leg. Roentgenograms and tomograms of the left tibia were normal. Radionuclide bone scan showed diffuse increased uptake in the whole tibia and a CT scan of the same region demonstrated an unusual pattern of bone tumor. Tibial biopsy revealed intra medullary steatonecrosis and led to the discovery of a pancreatic carcinoma.

Topics: Adenocarcinoma; Aged; Bone Marrow; Fat Necrosis; Female; Humans; Necrosis; Pancreatic Neoplasms; Technetium Tc 99m Medronate; Tibia