Prostate metastases (sclerotic)

Case contributed by A.Prof Frank Gaillard

Presentation

Increasing right hip pain.

Patient Data

Age: 85
Gender: Male
X-ray

Patchy focal sclerosis throughout pelvis and both femora consistent with sclerotic metastases.

RADIOPHARMACEUTICAL: 99mTc RBC, 775 MBq

There is intense radiotracer uptake in multiple ribs bilaterally with a mottled appearance, most prominent in the left 5th and right 6th ribs with tracking along the ribs and in 9th rib on the right side anteriorly. Foci are also seen in the left acetabulum, sacrum especially lateral to the left sacroiliac joint, left greater trochanter, both humeral heads, left acromioclavicular joint and manubrium.

Note was made of increased radiotracer uptake in a pattern consistent with degenerative changes in both elbows, knees and mid feet.

OVERALL IMPRESSION

Widespread bony metastases. No obvious explanation for the right hip pain is seen.

Axial imaging with multiplanar reformats of the lumbar spine have been obtained. Normal alignment maintained. Bones and densely sclerotic consistent with known metastatic disease.

At L2/3 there is a moderate diffuse disc bulge which contributes to moderate canal stenosis. At L3/4 there is a mild diffuse disc bulge which contributes to mild canal stenosis. At L4/5 there is a marked diffuse disc bulge which contributes to marked canal stenosis. Diffuse disc bulge contributes to mild canal stenosis at L5/S1. Remaining disc levels are unremarkable.

Non contrast spiral CT with multi planar reformats of the pelvis and both hips have been performed. Extensive sclerotic metastatic disease again noted. No pathologic fracture identified

Case Discussion

Typical appearances of sclerotic metastases from prostate cancer.

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Case information

rID: 30283
Case created: 31st Jul 2014
Last edited: 28th Oct 2015
Inclusion in quiz mode: Included

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