Nephrogenic systemic fibrosis in a patient with renal failure demonstrating a "reverse superscan" on bone scintigraphy.
Nephrogenic systemic fibrosis (NSF) has been linked to utilization of gadolinium-based contrast agents in patients with renal impairment. We present a 19-year-old female patient with end-stage renal failure presenting with joint pains and subcutaneous nodules. She had a prior gadolinium-enhanced magnetic resonance angiography when she was 14 years old. Clinical findings revealed firm subcutaneous nodules in both thighs. Whole-body bone scan demonstrates tracer uptake predominantly in the soft tissues and muscles of the extremities with minimal bony uptake. Incisional biopsy of the left thigh nodule revealed features of NSF with a total pathological score of 4, highly consistent with NSF.
Department of Diagnostic Imaging, National University Health System, Singapore, Singapore. superkhor@hotmail.com
Lih Kin
LK
Khor
Kong Bing
KB
Tan
Hoi Yin
HY
Loi
Suat-Jin
SJ
Lu
D000293:Adolescent; D001842:Bone and Bones / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D054989:Nephrogenic Fibrosing Dermopathy / Q000150:complications* / Q000000981:diagnostic imaging* / Q000473:pathology; D011877:Radionuclide Imaging; D051437:Renal Insufficiency / Q000150:complications*; D055815:Young Adult