فهرست مطالب y-c tyan

Phosphate absorption can be blocked by over-the-counter antacids, such as calcium- magnesium-, and aluminum-containing products. Although it is rare to see hypophosphatemia induced by aluminum-containing antacids, the combination treatment using two kinds of aluminum-containing agents may significantly increase the risk of hypophosphatemia in clinical settings. We present a case of hepatocellular carcinoma, showing multiple hot spots while being investigated for metastatic cancer in a routine bone scan. Initial laboratory studies showed hypophosphatemia. Long-term treatment for upper gastrointestinal bleeding with antacids and sucralfate was remarkable in the patient’s past history. Compared with corresponding radiographic findings, multiple areas of increased uptake on the bone scan are consistent with osteomalacia and microfractures. This case demonstrates that antacid and sucralfate-induced osteomalacia can mimic bony metastasis in a hepatocellular carcinoma patient on bone scintigraphy. Additional imaging modality, laboratory surveillance or follow-up bone scintigraphy may be recommended for accurate diagnosis or an appropriate treatment plan for the patient.

Fibrous dysplasia is a rare benign bone disorder characterized by the fibrous tissue containing trabeculae of non-lamellar bone (woven bone) and occupying normal medullary spaces. The uptake of the radiotracer in the affected bone is variable, and specificity is too low to diagnose fibrous dysplasia in the bone scan.

We are presenting four cases with monostotic fibrous dysplasia which were detected incidentally on the routine planar bone scan while being investigated for a metastatic cancer work-up. During a cancer work-up at our institution, we find lesions of fibrous dysplasia showing significantly increased uptake on the bone scan which may mimic metastatic bone lesions.

The SPECT/CT increases diagnostic confidence and improves accuracy and specificity of a planar bone scan. These cases were all asymptomatic at the one-year follow-up The subsequent bone scan and radiography studies have revealed no progression of these bone lesions.

The SPECT/CT images increase the diagnostic accuracy of the bone scan, which may avoid unnecessary surgery or overtreatment of fibrous dysplasia as bone metastasis. Abbreviation: SPECT/CT = single photon emission computed tomography/computed tomography.