Thursday, January 17, 2008

A Classic Bone Scan Finding? Not This Time....

When the bone scan above appeared on my list, I got rather excited. Besides the metastatic disease (which was stable from an earlier bone scan), there is intense activity in the left hand. I had seen images of arterial injections in textbooks, and thought this might be such an anamoly. However, in questioning the technologists, it turns out that the patient had poor veins, and multiple attempts were made to access a vessel in the left hand. Ultimately, they injected into the dorsum of the hand, and the thumb, with infiltration at both levels. Notice (which I didn't at first) that the activity in the thumb is discrete from that of the remainder of the hand, which we would not expect with the "glove" appearance of an arterial injection:



(Image reproduced from Loutfi, et.al., J Nucl Med Technol. 2003 Sep;31(3):149-53; quiz 154-6.)

So, there you have it. Looks can be deceiving, especially in Nuclear Medicine!

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