title: The aetiology of solitary hot spots in the ribs on planar bone scans.
abstract: The aim of this study was to determine the aetiology of solitary hot spots in the ribs found at bone scintigraphy in patients with known extraskeletal malignancy. A group of 34 patients whose bone scans showed a solitary hot spot in a rib were identified retrospectively over a 4-year period. They all had a known extraskeletal malignancy. Aetiology of the rib hot spot was established in 26 patients based on a review of clinical features, radiographic findings and clinical follow-up. In eight cases it remained indeterminate. In 14 (41%) cases, the rib lesion was malignant in origin, 9 were due to metastasis and 5 due to direct spread from intrapulmonary malignancy. In 12 (35%) cases, it was benign. In the remaining 8 (24%) cases, the aetiology was indeterminate. In the subgroup of 14 hot spots confined to the anterior rib end, 5 (36%) were due to malignancy, 4 (28%) were benign and 5 (36%) were indeterminate. We conclude that solitary hot spots in the ribs of patients with known extraskeletal malignancy undergoing bone scintigraphy are frequently (41%) malignant in origin. This also applies when the hot spot is in the anterior rib end (36% malignant). Thus, such hot spots are far more sinister than previously reported and require careful clinical and radiographic evaluation.
authors.affiliation: Department of Radiology, Leicester Royal Infirmary, UK.
authors.forename: A D
authors.initials: AD
authors.lastname: Baxter
authors.forename: F V
authors.initials: FV
authors.lastname: Coakley
authors.forename: D B
authors.initials: DB
authors.lastname: Finlay
authors.forename: C
authors.initials: C
authors.lastname: West
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001847:Bone Diseases / Q000000981:diagnostic imaging / Q000473:pathology; D001859:Bone Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary*; D002277:Carcinoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000556:secondary*; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000473:pathology; D011877:Radionuclide Imaging; D012189:Retrospective Studies; D012272:Ribs / Q000000981:diagnostic imaging* / Q000473:pathology