|Case of the Week - Patient Summary 4496|
Peer Reviewed and Certified -
|Demographics: 60 y.o. woman|
|History & Chief complaint:|
| 60 y.o. asian female presents to clinic with shortness of breath. |
|Physical exam: Not Available|
|Summary of Findings:|
|Anterior/posterior images - whole body bone scan utilizing Tc-99 Medronate
> diffuse, hazy increased uptake of radiotracer is noted overlying bilateral thoraces and throughout the abdomen. A slight increase in radiottacer is noted lining the inferior abdomen.
> a "ring" of increased radiotracer is noted in the left lower chest/ left upper quadrant, seen better on the anterior projection.
>remainder of the scan demonstrates degenerative change involving the right knee, right sternomanubrial joint, and lower cervical spine. A large amount of contamination is present overlying the pelvis.
>a 7cm mass is noted in the left lobe of the liver which demonstrates central low attenuation and mild peripheral enhancement. There is no evidence of calcification on the noncontrast views. Multiple smaller hepatic lesions are noted worrisome for metastatic disease.
>large bilateral pleural effusions and a large amount of ascites is demonstrated.
| Mucinous Adenocarcinoma metastases to the liver of unknown primary but likely ovarian/colonic/pancreatic per pathology report from liver biopsy (CT guided).
Non-malignant pleural effusion per thoracentesis
|Some soft tissue neoplasms will exhibit variable degrees of avidity for skeletal radiotracer. The most common neoplasms to demonstrate skeletal radiotracer uptake being breast, lung, colon, melanoma, and neuroblastoma. The mechanism is not well understood, however, it is thought that this uptake is secondary to either radiotracer binding to tumor calcification (such as in mutinous carcinoma of the colon) or binding to a macromolecule secreted by the neoplasm.
Pleural effusions have been found to take up radiotracer approximately 61 % of the time, with an equal uptake in both benign and malignant effusions.