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A 76-year-old man with acute inferior myocardial infarction was treated with streptokinase. Two days later, severe rhabdomyolysis developed that was complicated by acute anuric renal failure that required dialysis. His peak serum creatinine kinase level was 85,000 u/l. Large areas of necrotic skin developed on his abdomen and lower limbs. Whole-body scintigraphy performed with 25 mCi Tc-99m PYP revealed extensive abnormal tracer uptake in the major muscle groups of the lower limbs, consistent with acute myocyte injury.

A 68-year-old man came to our institution for a bone scan to evaluate pain of recent onset in the anterior aspect of the pelvis. The results of plain radiographs of the pelvis were reported as normal. His medical history included surgical resection of a carcinoma of the sigmoid colon and transurethral resection of the prostate for urinary obstructive symptoms. Metastatic disease of the pelvic bones was suspected. Extensive evaluations failed to reveal any metastatic disease or specific cause of the pelvic pain.

A 64-year-old man recently underwent a right above-knee amputation for a gangrenous limb. Although the patient was given broad-spectrum antibiotics, he continued to have high fevers. A bone scan was initially performed to investigate the possible site of infection. An unexpected increase in soft-tissue uptake was seen in the proximal left calf. A striking distal-photon-deficient area was also noted. The results of a subsequent Ga-67 scan showed an increase in soft-tissue uptake in the proximal left calf with a distal area of decreased tracer accumulation. At surgery, the gastrocnemius-soleus complex was found to be gangrenous with a large distal area of nonviable tissue.

A 78-year-old man had watery diarrhea and recurrent peptic ulceration. Extensive investigation disclosed a markedly elevated serum gastrin level and a 3-cm-diameter tumor arising from the head of the pancreas. The patient underwent a laparotomy that confirmed a gastrinoma. No metastases were evident at surgery or on the preoperative CT and MRI. Two years later, the patient presented with recurrence of diarrhea and mild elevation of serum gastrin was noted. The results of two CT scans were both normal. An ln-111 Octreotide scan was performed that demonstrated at least seven hepatic metastases. Retrospective analysis of the CT scan revealed a subtle, low-density lesion consistent with metastasis in one of the slices.

KTB-Reports ; 93-2

KTB-Reports ; 93-2

A 27-year-old man was surgically treated with internal fixation and fasciotomy for a complex fracture of the right tibia and fibula. This was complicated by klebsiella species infection that was treated with extensive surgical debridement of bone, insertion of an exchange tibial nail, and bone grafting. A sinus developed over the anterior tibia, draining purulent material from which klebsiella species were again isolated. Further extensive debridement was undertaken and antibiotic therapy continued. A bone scintigram showed soft tissue hyperemia and changes thought to be compatible with recent surgery. Leukocyte scintigraphy, however, identified an infective collection in the anterior soft tissues of the tibia, contiguous with the large bony defect. Further debridement was undertaken using a free muscle flap to the anterior tibial defect.

A 61 -year-old diabetic man was hospitalized with a swollen painful right shoulder 3 weeks after rotator cuff surgery. His general practitioner had lanced the inflamed surgical wound and released 70 ml pus. A Tc-99m leukocyte scan showed intense uptake of autologous labeled leukocytes in the shoulder joint, with remarkable definition of the anatomy of the bursa. Anatomy is rarely defined in this way by Tc-99m leukocyte images.

A 92-year-old man with a painful right hip reported a history of transitional cell carcinoma of the kidney that had been surgically excised 6 years previously. Plain radiographs revealed a region of mixed cortical lysis and sclerosis with a widened transition zone and the periosteal sunburst reaction. Bone scintigraphy showed intense uptake in the right femur, extending into the soft tissues. Other sites of uptake compatible with metastases were also present. Biopsy of the femoral lesion confirmed metastatic transitional cell carcinoma.