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Year : 2020  |  Volume : 35  |  Issue : 2  |  Page : 162-164  

Rare case of diffuse splenic uptake on methylene diphosphonate bone scan in a patient with sickle cell disease


Department of Nuclear Medicine and PET-CT, Tata Main Hospital, Jamshedpur, Jharkhand, India

Date of Submission21-Oct-2019
Date of Acceptance30-Nov-2019
Date of Web Publication12-Mar-2020

Correspondence Address:
Dr. Girish Kumar Parida
Department of Nuclear Medicine and PET-CT, Tata Main Hospital, Jamshedpur - 831 001, Jharkhand
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijnm.IJNM_187_19

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   Abstract 


Extraskeletal tracer uptake in methylene diphosphonate (MDP) bone scan is not a common finding. There have been several case reports in the literature showing diffuse splenic uptake in MDP bone scan. We present a case of sickle cell disease, which showed diffuse splenic uptake on MDP whole-body bone scan.

Keywords: Methylene diphosphonate bone scan, sickle cell disease, splenic uptake


How to cite this article:
Parida GK, Mitra S, Muthu GS, Suman A. Rare case of diffuse splenic uptake on methylene diphosphonate bone scan in a patient with sickle cell disease. Indian J Nucl Med 2020;35:162-4

How to cite this URL:
Parida GK, Mitra S, Muthu GS, Suman A. Rare case of diffuse splenic uptake on methylene diphosphonate bone scan in a patient with sickle cell disease. Indian J Nucl Med [serial online] 2020 [cited 2020 Jul 13];35:162-4. Available from: http://www.ijnm.in/text.asp?2020/35/2/162/280446



A 33-year-old female with a history of sickle cell disease presented to our hospital complaining of multiple joint pain involving bilateral knee and elbow joints. Diagnostic imaging including X-rays of knee and elbow joints was unremarkable. As she continued to complain of pain, a bone scan was advised. After the intravenous administration of 780 MBq of99m Tc-methylene diphosphonate (99m Tc-MDP), flow and blood-pool images of the joints were obtained, followed by delayed whole-body images. There was no abnormal tracer accumulation in the flow and pool images. Whole-body images showed diffuse increased radiotracer uptake in the left upper quadrant of the abdomen just superolateral to the left kidney, suggesting uptake in the spleen [Figure 1]a and [Figure 1]b, anterior and posterior images, respectively]. There was no other abnormal tracer accumulation in the whole-body images. The patient had undergone noncontrast abdominal computed tomography abdomen for pain abdomen previously, which showed heterogeneous calcification in the splenic parenchyma [Figure 1]c, [Figure 1]e, transaxial images].
Figure 1:Diffuse increased radiotracer uptake in the left upper quadrant of the abdomen just superolateral to the left kidney, suggesting uptake in the spleen (a: anterior and b: posterior images). Heterogeneous calcification in the splenic parenchyma on computed tomography abdomen (tranaxial images, c-e)

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Few theories have been believed for splenic uptake in sickle cell disease. One of them is microscopic calcium deposits that may not get detected radiographically, but can cause uptake of99m Tc-MDP in spleen.[1] The other mechanism is hemosiderosis that occurs because of recurrent transfusion and increased deposition of iron from the sequestration of abnormal red blood cells within the spleen.[2],[3] Besides sickle cell disease, multiple other causes of splenic uptake have also been described in the literature. They include malignant hematologic diseases;[4],[5] recent gadolinium contrast agent injection;[6],[7],[8] alcoholic cirrhosis;[9] hypercalcemia;[10] hemochromatosis;[11] hypersplenism;[1] chronic hemolysis such as glucose-6-phosphate dehydrogenase deficiency or thalassemia;[12],[13] splenic hemangioma;[14] splenic hematoma, infarction, abscess, or metastasis;[15] amyloidosis;[16] and renal failure.[10] Hence, we can infer that extraskeletal uptake in MDP bone scan is not a usual finding. However, it should be kept in mind that this finding can be of certain clinical significance and should not be ignored.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

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Pak K, Kim SJ, Kim IJ, Suh KT. Hepatic uptake of Tc-99m DPD on bone scintigraphy: The influence of the interval with gadolinium-containing contrast of MRI. Clin Nucl Med 2012;37:134-6.  Back to cited text no. 8
    
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Kawamura E, Kawabe J, Hayashi T, Oe A, Kotani J, Torii K, et al. Splenic accumulation of Tc-99m HMDP in a patient with severe alcoholic cirrhosis of the liver. Clin Nucl Med 2005;30:351-2.  Back to cited text no. 9
    
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Shimpi MM, Singh N, Gupta N. Unusual visceral distribution of technetium-99m-methylene diphosphonate in a case of hypercalcemia of malignancy. Indian J Nucl Med 2016;31:67-8.  Back to cited text no. 10
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11.
Sabnis SS, Blend MJ. Splenic uptake of Tc-99m MDP in a patient with hemochromatosis. Clin Nucl Med 1999;24:622-3.  Back to cited text no. 11
    
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Perlmutter S, Jacobstein JG, Kazam E. Splenic uptake of 99mTc-diphosphonate in sickle cell disease associated with increased splenic density on computerized transaxial tomography. Gastrointest Radiol 1977;2:77-9.  Back to cited text no. 12
    
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Howman-Giles RB, Gilday DL, Ash JM, Brown RG. Splenic accumulation of Tc-99m diphosphonate in thalassemia major. J Nucl Med 1978;19:976-7.  Back to cited text no. 13
    
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Katz DS, Wojtowycz AR, Markarian B. Splenic hemangioma. Detection on a technetium-99M MDP bone scan. Clin Imaging 1994;18:279-82.  Back to cited text no. 14
    
15.
Costello P, Gramm HF, Steinberg D. Simultaneous occurrence of functional asplenia and splenic accumulation of diphosphonate in metastatic breast carcinoma. J Nucl Med 1977;18:1237-8.  Back to cited text no. 15
    
16.
Ravanbod MR, Nemati R, Javadi H, Nabipour I, Assadi M. Diffuse hepatic and spleen uptake of Tc-99m MDP on bone scintigraphy resembling liver-spleen scintigraphy in a patient of plasma cell tumor. Case Rep Radiol 2014;2014:264904.  Back to cited text no. 16
    


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