-History: Young man with history of mild anemia presents with occasional body aches, now in upper lateral back.

-Radiologic findings: Anterior and posterior nuclear medicine bone scan images of the whole body demonstrate abnormal radiopharmaceutical accumulation in the soft tissues of the upper lateral back, in the region of the teres muscles, left greater than right. The patient admitted to local pain.

-Differential Diagnosis: Trauma (repetitive stress, rhabdomyolisis, direct, myositis ossificans), Ischemia, Iron dextran injection.

- Diagnosis: Rhabdomyolysis

-Discussion:
When analyzing bone scans, it is always good to start with the soft tissues and then proceed to the bones. This patient had recently started on a weight training routine and reported unusual severe soreness after a workout. As the bone scan images demonstrate, there is increased radiotracer accumulation along the length of the teres muscles bilaterally, greater on the left.
   The proposed mechanism of uptake of the radiopharmaceutical is absorption of denatured proteins or binding to mitochondrial calcium, which is increased in ischemic tissues.