Arterial injection of TC-99m-MDP (bone scan)

Case contributed by Karina Dorfman
Diagnosis certain

Presentation

Isotope bone scan for evaluation of diffuse skeletal pain.

Patient Data

Age: 60 years
Gender: Male

Delayed phase bone scan

Nuclear medicine
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Info

Diffusely increased Tc-99m-MDP uptake distal to the injection site in left cubital fossa.

Case Discussion

Inadvertent arterial injection of radiopharmaceutical is occasionally seen in bone scans.

Arterial injection leads to altered biodistribution of MDP, with tissues downstream to the injection site receiving high concentration of MDP which results in a “hot-hand” appearance, as seen in this case.

No relevant abnormality was demonstrated that could explain his symptoms.

In cases of more distal arterial injection, a “glove” appearance happens.

Distal uptake can also occur in complex regional pain syndrome, however there will be a history of injury.

Courtesy of Dr. Michal Weiler-Sagie.

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