Limbus Vertebra on Bone Scintigraphy in a Pediatric Patient

The Great Mimickers of Spinal Pathology

Back pain is one of the leading causes of health costs worldwide, particularly because of the further increased aging population. After clinical examination, spinal imaging is of utmost importance in many patients to reach the correct diagnosis. There are many imaging pitfalls and mimickers of spinal pathology on radiographs, magnetic resonance imaging, and computed tomography. These mimickers may lead to a misdiagnosis or a further imaging work-up if they are not recognized and thus lead to unnecessary examinations and increased health care costs. In this review we present the common mimickers of spinal pathology and describe normal variations when reading imaging studies of the spine.

Solitary Thumb Acrometastasis Identified on Bone Scintigraphy

A 45-year-old man with a history of adenocarcinoma in the right lung 3 years ago underwent a Tc-MDP bone scan to evaluate possible osseous metastasis. The images demonstrated intense activity in the region of left thumb, while the tracer uptakes in other bones were not typical of metastases. A CT of the hand showed diffuse sclerotic changes with destructed trabecular structure in the proximal phalanx of the left thumb. The left thumb was subsequently resected, and the pathological examination of the resected left first metacarpal bone confirmed the diagnosis of metastasis of lung adenocarcinoma.

Massive Pelvic Lymphadenopathy Due to Recurrent Non-Hodgkin Lymphoma Incidentally Revealed on a 99mTc-MDP Bone Scintigraphy

A 58-year-old man underwent Tc-MDP bone scintigraphy to evaluate the cause of diffuse bone pain. The images did not identify the exact cause of his symptoms. However, a "light bulb"-shaped urinary bladder and diffused increased activity in the scrotal region and left thigh were noted, which suggest a mass effect in the pelvis. A CT scan of the pelvis revealed soft tissue compressing the urinary bladder. A diagnosis of recurrent lymphoma was made.

Primary Osteosarcoma of the Rib Identified on Bone Scintigraphy

Osteosarcomas generally arise in appendicular skeletons, but rarely in the ribs. We described Tc-MDP bone scan findings from a 23-year-old man with right back pain. The images demonstrated elevated activity in the region overlapping the posterior 8th to 10th ribs and in the L9-10 vertebral bodies. CT showed an 8.8 × 8.3 cm mildly peripherally calcified mass arising from the right 10th rib involving the 9th and 10th thoracic vertebrae. Pathological examination confirmed primary osteosarcoma of the rib.