title: Reduced hemithoracic uptake on 99mTc-MDP bone scintigraphy: an underrecognized sign of massive pleural effusion--a case report.
abstract: The uptake of (99m)Tc-methylene diphosphonate (MDP) in malignant pleural effusions and, rarely, in nonmalignant pleural effusions has been well documented in the literature. Although the exact mechanism of uptake in these conditions remains unclear, there have been attempts to use the bone scintigraphic features of pleural effusion to predict sensitivity and specificity for malignancy based on pleural fluid cytology. It has been suggested that activity in the chest increases with an increase in effusion volume. We report here, however, a case of malignant pleural effusion, that showed reduced hemithoracic activity in contrast to the expected increased activity. Our experience highlights the need for an open and inquisitive mind to avoid diagnostic pitfalls when confronted with a bone scintigram showing reduced uptake unilaterally or bilaterally in the chest.
authors.affiliation: Department of Nuclear Medicine, Addenbrooke's Hospital, Cambridge, United Kingdom. kottekkattu.balan@addenbrookes.nhs.uk
authors.forename: Kottekkattu K
authors.initials: KK
authors.lastname: Balan
authors.forename: Somasundaram
authors.initials: S
authors.lastname: Ramkumar
authors.forename: Karwan
authors.initials: K
authors.lastname: Faraj
authors.forename: Arabinda K
authors.initials: AK
authors.lastname: Choudhary
mesh_terms: D000368:Aged; D001859:Bone Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary; D001842:Bone and Bones / Q000000981:diagnostic imaging*; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology; D008297:Male; D016066:Pleural Effusion, Malignant / Q000000981:diagnostic imaging*; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D013669:Technetium Tc 99m Medronate
chemical_list: D019275:Radiopharmaceuticals; D013669:Technetium Tc 99m Medronate