Diffuse Pulmonary Uptake of Tc-99m Methylene Diphosphonate in a Patient with Non-tuberculosis Mycobacterial Infection

Abstract

Extra-osseous uptake of bone-seeking radiopharmaceuticals has been reported at various sites and it is known to be induced by various causes. Diffuse pulmonary infection, such as tuberculosis, can be a cause of lung uptake of bone-scan agent. Here we report on a patient with non-tuberculosis mycobacterial infection (NTM) who demonstrated diffuse pulmonary uptake on Tc-99m MDP bone scan. After medical treatment for NTM, the patient's lung lesions improved. Extraskeletal lung Tc-99m MDP uptake on bone scan may suggest lung parenchymal damage associated with disease activity.

Diffused Pulmonary Uptake of Tc-99m Methylene Diphosphonate Bone Scan in Patient with Prostate Cancer without Blood Test and Correlative/Cross-Sectional Imaging Abnormalities: A Case Report

“…There have been reports of hydroxyapatite crystals in the mitochondria of some necrotic tissues in pulmonary tuberculosis patients. Mycobacteria-induced lung parenchymal injury resulted in an increase in calcium-binding capacity and Tc-99m MDP chemisorption [2]. There was no evidence of a mycobacterial tuberculosis pattern in our case's imaging, and there was no prior infection with or treatment for tuberculosis in this patient's history.…”

“…A common procedure for assessing bone metastases in cancer patients is a bone scan using Tc-99m methylene diphosphonate (MDP) [1]. Extra-osseous pulmonary uptake of bone scan occurs in a wide variety of disorders, including hyperparathyroidism, hematologic malignancy, metastasis, renal failure, vasculitis, lung infection, and amyloidosis involvement, and is typically found as an incidental finding [2][3][4][5][6]. When faced with incidental observations of non-osseous pulmonary uptake, clinicians should be aware of any clinical symptoms, blood tests, or imaging that may indicate the existence of an unsuspected disease process [7].…”

A rare case and review of pulmonary ossification

“…The extraosseous accumulation of technetium-99m-methyl diphosphate (99mTc-MDP) on a bone scan is rare and often associated with abnormal calcium metabolism [ 27 , 28 ]. Although this pattern is seen in a handful of other malignancies and infections such as acute lymphocytic leukemia, breast cancer, and non-tuberculosis mycobacterium, the combination of 99mTc-MDP positivity with nodular or dendriform characteristic morphology in the lungs has only been observed in pulmonary ossification [ [28] , [29] , [30] ].…”

Bone Scan With Pulmonary Uptake in Scleroderma

“…In our case report, there was significant pulmonary MDP uptake in a known case of scleroderma with lung involvement of NSIP. The exact mechanism for accumulation of bone imaging agents in the inflammatory foci is not clear, but it is thought to be secondary to increased blood flow or dystrophic calcification caused by tissue necrosis 9 . This observation may suggest active lung disease and leads to further evaluation and changing management.…”

“…Pulmonary MDP uptake is often an incidental finding and suggestive of lung damage 5 . Diffuse lung uptake has been reported in various disease states including multiple myeloma, lung metastases, vitamin D intoxication, hyperparathyroidism, pulmonary alveolar microlithiasis, 6 Waldenstrom macroglobulinemia, 7 amyloidosis, 8 pulmonary infection, 9 vasculitis, 5 sarcoidosis, radiation therapy, idiopathic pulmonary ossification, and berylliosis 10 . In our case report, there was significant pulmonary MDP uptake in a known case of scleroderma with lung involvement of NSIP.…”