Intramedullary fat necrosis of multiple bones associated with pancreatitis.
We describe findings of intramedullary fat necrosis on five imaging studies in a patient with alcoholic pancreatitis. Radiography and CT of extremities showed multiple osteolytic lesions that were initially considered to be metastases. However, a 99mTc-methylene diphosphonate whole-body bone scan revealed abnormal areas of increased uptake in only the bones of extremities without involvement of the axial skeleton, a distribution quite unusual for metastatic disease. Furthermore, 99mTc-sestamibi scintigraphy was essentially normal. MRI revealed findings compatible with the diagnosis of fat necrosis/infarct. Findings from bone biopsy demonstrated necrotic bone marrow without malignant cells. It may not be necessary to perform all the imaging studies described in this report when clinical features suggesting metastatic fat necrosis are present. Appearance and distribution of abnormalities on the whole-body bone scan and MR images show that necrosis/infarct of the marrow may obviate bone biopsy, which is often needed to confirm the diagnosis of intramedullary fat necrosis and to exclude neoplastic processes.
Department of Nuclear Medicine, Kyungpook National University School of Medicine, Taegu, Korea.
B C
BC
Ahn
J
J
Lee
K J
KJ
Suh
K A
KA
Chun
S K
SK
Sohn
K
K
Lee
C K
CK
Kim
D000368:Aged; D001842:Bone and Bones / Q000000981:diagnostic imaging* / Q000473:pathology; D005218:Fat Necrosis / Q000000981:diagnostic imaging* / Q000209:etiology; D006801:Humans; D008297:Male; D019512:Pancreatitis, Alcoholic / Q000150:complications / Q000000981:diagnostic imaging*; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D013669:Technetium Tc 99m Medronate; D017256:Technetium Tc 99m Sestamibi
D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi; D013669:Technetium Tc 99m Medronate