Renal osteodystrophy - metabolic superscan


The appearance of the bone scan is consistent with a "metabolic superscan," in this case due to secondary hyperparathyroidism (renal osteodystrophy).  Note that activity is increased throughout the entire skeleton, including the distal appendicular skeleton, which is characteristic of a superscan due to metabolic disorders.  In contradistinction, a metastatic superscan will typically affect only the axial and proximal appendicular skeleton.  Another differential consideration for this case would include multifocal Paget disease, although the appearance would typically not be so uniform.