technetium-tc-99m-medronate and Shoulder-Pain

Os acromiale is an anatomic variant that in rare cases can cause pain. (99m)Tc-methylene diphosphonate bone scintigraphy with SPECT/CT can play an important role in diagnosing this clinical entity. We present a male football player with shoulder pain secondary to a symptomatic os acromiale, and we demonstrate the findings on bone scanning with limited SPECT/CT that diagnosed this important clinical abnormality.

Topics: Acromion; Adolescent; Bone Diseases, Developmental; Diagnosis, Differential; Humans; Male; Multimodal Imaging; Radiopharmaceuticals; Shoulder Pain; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

Osteomalacia can be a late but unrecognized complication following jejunoileal bypass. We describe a 53-year-old man who underwent jejunoileal bypass for morbid obesity twenty years earlier who suffered from progressive diffuse bony pain refractory to nonsteroidal anti-inflammatory drugs. He was initially diagnosed with a malignancy with bone metastasis. However, pertinent laboratory data were notable for hypocalcemia (7.5 mg/dL, albumin 4.1 mg/dL) with low urinary calcium excretion (14 mg/day), hypophosphatemia (2.0 mg/dL) with low urinary phosphate excretion (53 mg/day), hypomagnesemia (1.5 mg/dL) with low urine magnesium excretion (23 mg/day), low 1, 25 (OH)2 vitamin D3, and elevated serum alkaline phosphatase and intact parathyroid hormone (iPTH). These laboratory findings pointed to a defect in calcium, phosphate, and magnesium handling in the gastrointestinal tract. Bone biopsy of the iliac crest clearly demonstrated typical changes of osteomalacia with excessive osteoid accumulation and reduced mineralization. His clinical symptoms were refractory to oral 1, 25 (OH)2 vitamin D3 and calcium supplementation but significantly improved with the addition of intermittent intravenous active 1, 25 (OH)2 vitamin D3, calcium, phosphate, and magnesium supplementation. Osteomalacia is an easily misdiagnosed late complication of jejunoileal bypass. Early recognition can avoid circuitous diagnosis and inappropriate management.

Topics: Biopsy; Chest Pain; Diagnosis, Differential; Hip; Humans; Ilium; Jejunoileal Bypass; Male; Middle Aged; Osteomalacia; Pain, Postoperative; Postoperative Care; Radionuclide Imaging; Shoulder Pain; Technetium Tc 99m Medronate

Topics: Adolescent; Antigens, CD; Dancing; Humans; Male; Radionuclide Imaging; Shoulder Injuries; Shoulder Joint; Shoulder Pain; Technetium Tc 99m Medronate

Patients with benign solitary enchondromas of the proximal humerus frequently present to the diagnosing physician with shoulder pain. Once the lesion is considered benign, emphasis can be placed on identifying the etiology for the pain. We reviewed our experience with these patients to identify the cause of the presenting pain. A retrospective review of clinical records and radiographic studies (radiographs, magnetic resonance images, and bone scans) was done for all patients presenting to an orthopaedic oncology unit with solitary enchondroma of the proximal humerus. Attention was focused on diagnostic evidence of additional disease in the shoulder. Fifty-seven patients (mean age, 53.6 years) met the criteria of the study and were included for evaluation. Of patients presenting with pain, 82% (47 of 57 patients) had findings seen on magnetic resonance imaging scans that correlated with the initial clinical diagnostic impression, suggesting that other disease was present that could explain the pain. Solitary enchondromas of the proximal humerus often are found incidentally during the initial evaluation of patients with shoulder pain. This study showed that additional treatable disease usually is present in patients with enchondromas of the proximal humerus.

Topics: Acromioclavicular Joint; Algorithms; Biopsy; Bone Neoplasms; Chondroma; Comorbidity; Female; Humans; Humerus; Magnetic Resonance Imaging; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Rotator Cuff; Shoulder Impingement Syndrome; Shoulder Pain; Technetium Tc 99m Medronate; Tendinopathy

Topics: Adult; Arm; Bone and Bones; Humans; Incidental Findings; Low Back Pain; Male; Military Personnel; Myofascial Pain Syndromes; Radionuclide Imaging; Radiopharmaceuticals; Rhabdomyolysis; Shoulder Pain; Technetium Tc 99m Medronate

Topics: Bone and Bones; Child; Humans; Liver Abscess; Male; Radionuclide Imaging; Radiopharmaceuticals; Shoulder Pain; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

This study investigated the feasibility of ordered subsets expectation maximisation (OS-EM) reconstruction of pinhole single-photon emission tomography (SPET) acquired with a tilted detector head and a 180 degrees orbit. Phantom and patient data were recorded using a standard single-head camera. Reconstructions were performed using a dedicated OS-EM algorithm. Reconstructed images of line, uniformity and Picker's thyroid phantoms showed that the geometry, physical size and uniformity of the radioactive objects were preserved. For the range of radius corresponding to the patient studies, the measured full-widths at half-maximum lay between 4.90+/-0.25 mm and 6.05+/-0.25 mm. Finally, the gain in resolution associated with the use of the pinhole collimator instead of a parallel-hole collimator was highlighted in a parathyroid exploration and in a shoulder bone study.

Topics: Aged; Algorithms; Female; Humans; Hyperparathyroidism; Image Processing, Computer-Assisted; Middle Aged; Osteoporosis; Phantoms, Imaging; Radiopharmaceuticals; Shoulder Pain; Technetium Tc 99m Medronate; Technetium Tc 99m Sestamibi; Tomography, Emission-Computed, Single-Photon