Min-Woo Kim

Unusual bone scintigraphic findings of secondary myelofibrosis associated with disseminated tuberculosis before and after therapy.

This case concerns a patient with secondary myelofibrosis associated with disseminated tuberculosis who manifested unusual bone scintigraphic findings. The bone images showed a generalized increased uptake in the axial skeleton, including the clavicles and mandible and the proximal long bones similar to a Superscan, and multiple hot spots similar to metastatic disease, combined with increased activity of the metaphyseal ends of the appendicular bones, including the joints. The bone scintigraphs obtained 17 months after antituberculous therapy showed progressive improvement in the known lesions, accompanied by the appearance of new lesions and the apparent visualization of some lesions that may be identical to a flare phenomenon.

Tc-99m RBC perfusion and blood-pool scintigraphy in the evaluation of vascular leiomyoma of the hand

A 62-year-old man with a soft, non-tender, movable mass 2.5×2.5-cm in diameter in the volar surface of the right index finger over the proximal phalanx underwent Tc-99m RBC perfusion and blood-pool scintigraphy to evaluate the vascular nature and extent of the mass. Highly increased activity on early and delayed blood-pool images with increased perfusion was demonstrated in the mass. The lesion with high flow rates and large blood pool spaces was considered highly suggestive of one of the various types of peripheral hemangioma. Angiography revealed a vascular neoplasm with tumor vessels. Microscopic examination of the resected tumor revealed vascular leiomyoma containing numerous dilated vascular channels. These scintigraphic abnormalities were regarded as resulting from hypervascularity demonstrated angiographically and blood pooling within the dilated vascular channels demonstrated histologically. It is concluded that Tc-99m RBC perfusion and blood pool scintigraphy may be an important non-invasive approach to demonstrate vascular leiomyoma prior to surgical biopsy or resection.

Compression of the anterior mediastinum by uremic tumoral calcinosis unusually involving the sternoclavicular joint.

Uremic tumoral calcinosis is an uncommon disease that occurs in patients with chronic renal failure receiving regular, long-term hemodialysis, and characterized by calcified periarticular soft tissue masses, often of considerable size and multiplicity. The present case describes a 36-year-old man who had been on hemodialysis for 8 years. Uremic tumoral calcinosis occurred at unusual sites, the sternoclavicular joints, with simultaneous involvement of the shoulder and hip joints, and accompanied by renal osteodystrophy on bone scintigraphy. In addition, the calcified masses at the stemoclavicular joints extended into and compressed the anterior mediastinum, an unusual occurrence seen on chest computed tomography.