Bone Scanning Findings in a Patient with Heat Stroke–Induced Rhabdomyolysis

Abstract

We present a case that caused a diagnostic dilemma on a bone scan. We also review the broad spectrum of nonmalignant findings that can impact the interpretation of a bone scan and the value of correlative imaging using SPECT/CT for exact localization and characterization of lesions. The imaging features of important benign pathologies-that is, metastatic mimics-are elaborated so that the reader can avoid misinterpretations when reporting them. We elucidate 4 uncommon benign findings on a bone scan. Rhabdomyolysis is a result of lysis of skeletal muscle with release of cell contents, such as myoglobin and muscle enzymes, and is diagnosed mostly through a combination of clinical appearance and laboratory values. Myositis ossificans is the most common form of heterotopic ossification, usually occurring within large muscles. Its importance stems largely from its ability to mimic more aggressive pathologic processes. Myositis ossificans is one of the skeletal "do not touch" lesions. Such bone lesions are defined by characteristic imaging features, the identification of which precludes the need for additional diagnostic tests or biopsies, thereby avoiding unnecessary interventions. Acute tubular necrosis is kidney injury caused by damage to the kidney tubule cells (kidney cells that reabsorb fluid and minerals from urine as it forms). Common causes are low blood flow to the kidneys, drugs that damage the kidneys, or a severe underlying infection.

ZBP1 and heatstroke

“…ALI was also found in mouse and rat models of heatstroke (21,99,158,(177)(178)(179)(180)(181)(182)(183). Rhabdomyolysis is more common in patients with EHS, and several possible mechanisms cause such phenomenon (3,166,(184)(185)(186)(187)(188)(189)(190)(191)(192)(193). One potential mechanism is the elevated muscle tension caused by strenuous activity, which increases the chance of tissue injury (184).…”

Predictive value of serum myoglobin and lactate dehydrogenase in rhabdomyolysis-induced acute kidney injury from severe heatstroke

“…RM, a hallmark of severe heatstroke, involves primary or secondary skeletal muscle damage, releasing potentially toxic substances into the bloodstream. This condition is marked by striated muscle injury and muscle fiber necrosis, causing substantial cellular content release into the renal tubules, leading to acidic urine deposition and renal obstruction, subsequently precipitating acute kidney injury (AKI) [5]. AKI, a critical RM complication, has an incidence rate of 13%-50% and a mortality rate of 20%-50% [6].…”

A Case Report of a Gluteus Hematoma Detected on 99mTc-MDP Bone Scan

“…This paper is the first report of gluteal hematoma in a whole-body bone scan to the best of our knowledge. There were only a few reports on soft tissue hematoma on other sites, such as brachialis muscle and chest wall hematoma findings on whole-body bone scans [ 5 , 6 ]. A whole-body bone scan may be one of the most valuable diagnostic tools to assess the multiple numbers of traumatic lesions in the whole skeletal system but also traumatic soft tissue lesions such as hematoma.…”