technetium-tc-99m-medronate and Pleural-Effusion--Malignant

We report a patient with a sympathetic pleural effusion secondary to T-cell lymphoma that accumulated the bone imaging agent, Technetium-99m-methylene diphosphonate (99mTc-MDP). This case is significant in that malignant cells were not present on three cytologic examinations of the pleural fluid or multiple pleural biopsies. We also present a review of the published literature on pleural effusions that accumulate bone tracers. We conclude that pleural effusions that accumulate 99mTc-MDP should be considered malignant or secondary to a malignancy and further work-up is essential even if the cytologic exam of the pleural fluid is unremarkable.

Topics: Aged; Humans; Lymphoma, T-Cell; Male; Pleural Effusion, Malignant; Radionuclide Imaging; Technetium Tc 99m Medronate

The literature is replete with cases of Tc-99m bone imaging agent uptake in pleural effusions. Far rarer is the report of photopenia in a pleural effusion. In this case of malignant mesothelioma, we describe a unique case of unilateral hemithoracic photopenia from a pleural effusion with concomitant uptake in the contralateral lung resulting from calcified pleural plaques. Although initially perplexing clinically, this case can be readily explained with an understanding of basic physiological principles.

Topics: Aged, 80 and over; Bone Neoplasms; Diagnosis, Differential; False Positive Reactions; Humans; Male; Mesothelioma; Pleural Effusion, Malignant; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

Topics: Bone Neoplasms; Humans; Lung Neoplasms; Male; Middle Aged; Osteolysis; Osteosarcoma; Pleural Effusion, Malignant; Radionuclide Imaging; Radiopharmaceuticals; Ribs; Technetium Tc 99m Medronate

The uptake of (99m)Tc-methylene diphosphonate (MDP) in malignant pleural effusions and, rarely, in nonmalignant pleural effusions has been well documented in the literature. Although the exact mechanism of uptake in these conditions remains unclear, there have been attempts to use the bone scintigraphic features of pleural effusion to predict sensitivity and specificity for malignancy based on pleural fluid cytology. It has been suggested that activity in the chest increases with an increase in effusion volume. We report here, however, a case of malignant pleural effusion, that showed reduced hemithoracic activity in contrast to the expected increased activity. Our experience highlights the need for an open and inquisitive mind to avoid diagnostic pitfalls when confronted with a bone scintigram showing reduced uptake unilaterally or bilaterally in the chest.

Topics: Aged; Bone and Bones; Bone Neoplasms; Humans; Lung Neoplasms; Male; Pleural Effusion, Malignant; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

Topics: Bone and Bones; Breast Neoplasms; Female; Humans; Lung Neoplasms; Middle Aged; Pleural Effusion, Malignant; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

A malignant solitary fibrous tumor arising in the right buttock associated with metastatic parietal pleural and intrapulmonary tumors and pleural effusion was found in a 59-year-old man. A chest computed tomogram revealed three tumors attached to the parietal pleura with rib destruction, and a tumor in the left lower lung field. Histologically, the tumors of the buttock and parietal pleura were characterized by proliferation of bundles of spindle-shaped or oval cells separated by wavy hyalinized collagen tissue with no expression of cytokeratin, S-100 protein, muscle actin or epithelial membrane antigen, but these cells weakly expressed CD34 and strongly expressed vimentin.

Topics: Biomarkers, Tumor; Buttocks; Combined Modality Therapy; Extracellular Matrix Proteins; Follow-Up Studies; Humans; Immunohistochemistry; Lung Neoplasms; Male; Middle Aged; Neoplasms, Fibrous Tissue; Pleural Effusion, Malignant; Pleural Neoplasms; Radiography, Thoracic; Radiopharmaceuticals; Soft Tissue Neoplasms; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

Asymmetric chest activity with malignant and benign pleural effusions has been described in bone scans. However, the clinical utility of this finding is not elucible from the literature. We developed specific scintigraphic criteria for malignant pleural effusion and retrospectively assessed their sensitivity and specificity in a group of patient scans.. Pleural fluid was submitted for cytopathology from 850 patients over a 5-yr period. Bone scans were done within 2 mo of the thoracentesis in 74 patients. As a consensus panel, we reread the scans and reviewed the cytology.. The effusions were cytologically malignant in 25/74 patients (34%), indeterminate in 9/74 (12%) and benign in 40/74 (54%). Based on cytopathology, malignant pleural effusions were detected by bone scans with a sensitivity of 34%-50% and a specificity of 78%-89%; true sensitivity and specificity was somewhere in between averaging 42% (95% confidence interval 24%-60%) and 84% (95% confidence interval 73%-95%), respectively.. The bone scan is frequently the first examination suggesting pleural metastasis, and when it is detected it should be pursued beyond pleural fluid cytology, if negative or indeterminate.

Topics: Adult; Bone and Bones; Female; Humans; Male; Middle Aged; Pleural Effusion, Malignant; Radionuclide Imaging; Retrospective Studies; Sensitivity and Specificity; Technetium Tc 99m Medronate

Seventy-six patients with malignant or benign pleural effusion were studied to determine the incidence of accumulation of 99mTc-MDP in relation to effusion, and reveal the mechanism. Of 76 patients, 46 (61%) were found to have diffuse uptake of 99mTc-MDP in the hemithorax, with almost the same positive rate in malignant and benign effusions, i.e. 62% and 57%, respectively. Of 46 patients, 32 (70%) showed diffuse, slight accumulation in the hemithorax, and the positive rate had a tendency to be higher with the increase in the effusion volume. We are convinced that the major mechanism of unilateral intrathoracic accumulation of 99mTc-MDP in pleural effusion is a passive transudation.

Topics: Adult; Aged; Aged, 80 and over; Bone and Bones; Female; Humans; Japan; Male; Middle Aged; Pleural Effusion; Pleural Effusion, Malignant; Radionuclide Imaging; Retrospective Studies; Technetium Tc 99m Medronate