Metastatic visceral calcification identified by bone scanning

Abstract

The scintigraphic abnormalities with radionuclide bone scanning observed in a patient with metastatic breast carcinoma associated with hypercalcaemia are described. Abnormal uptake of 99mTc-pyrophosphate was noted in the lungs, stomach, myocardium, kidneys, and thyroid, indicating metastatic visceral calcification. A scan performed 72 h later when she was normocalcaemic showed marked reduction in the accumulation in the myocardium and thyroid. In a further scan, 18 months later, no extraosseous uptake was present. A review of 26 reported cases of visceral metastatic calcification with scintigraphic abnormalities indicates that the changes in this patient were more widespread and that in only two of the previous cases similar total resolution had been observed. The reasons for the discrepancy between the incidence of visceral calcification on autopsy and on scintigraphic examination are discussed in relation to the aetiological factors. It is concluded that bone scanning offers a useful method for identifying visceral calcification, except when associated with uncomplicated renal failure, and is valuable in detecting this abnormality in patients with hypercalcaemia and in the assessment of response to therapy.

Scintigraphy in the clinical evaluation of disorders of mineral and skeletal metabolism in renal failure

“…In favour of this view is the increased gastric uptake reported in patients with hypercalcaemia and/or acute renal failure (13/26 patients, Choy and Murray 1980), presumably reflecting hydroxyapatite-like deposits in these patients.…”

“…Visceral calcifications in these patients were thought to consist initially of brushite with subsequent transformation to hydroxyapatite in vivo (Alfrey et al 1976a). These deposits should demonstrate good adsorption of diphosphonates, and there have been many reports in the literature of uptake of diphosphonates, polyphosphates, pyrophosphate and strontium, particularly in lungs and stomach (Rosenthal et al 1977;Choy and Murray 1980;Coolens et al 1985).…”

“…In a survey of case reports of patients with diffuse uptake in pulmonary calcifications (Choy and Murray 1980), only 5 of the 26 patients studied also showed uptake in the myocardial region, and only 1 of these 5 was a patient on chronic haemodialysis. Three other patients on chronic dialysis have since been described (Seid et al 1981 ;Atkins and Oster 1984;Kida et al 1986).…”

Diffuse Calcinosis and Intradermal Tophi in a Uremic Patient: Effect of Low-Calcium Hemodialysis and Mechanism of Hypercalcemia

“…Bone scan is a more sensitive tool to detect and monitor soft tissue calcification [2,3]. Calcification of the skin (known as calcinosis cutis), characterized by the deposition of hydroxyapatite crystal in the derma, is a rare soft tissue calcification [4,5].…”

“…the lungs, stomach and kidney [1]. However, hyperphosphatemia is typically associated with crystal hydroxyapatite deposits [3Ca 3 (PO 4 ) 2 W Ca(OH) 2 ] in non-visceral organs, e.g. skin or vessels [1].…”