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Bone Case 15 Answers

1. What is the striking abnormality on this scan?

There is intense myocardial uptake. This should not be confused with pericardial uptake.

2. What are the possible causes for this finding?

Myocardial uptake can be seen in

  • myocardial infarction
    drug-related injury (e.g. Adriamycin)
    myocarditis (e.g. viral or transplant rejection)
    external beam radiotherapy
    ventricular aneurysm
    thermal injury from electrocution

Inadvertent blood pool imaging can result in cardiac uptake and is not a problem with delayed imaging undertaken in most cases.

3. Is there any particular cause that would be relevant to this patient's history?

There seems to be a strong association between prostate cancer and cardiac uptake. One study revealed increased myocardial uptake in 19 of 965 scintigrams. Most of the male patients with increased myocardial uptake had prostatic carcinoma (13/17) and were over 80 years of age (12/17). None had cardiac disease or cardiac infiltration by metastases. Although uptake of radiophosphates has been traditionally attributed to asymptomatic atherosclerotic changes associated with old age, no aetiological link with prostatic carcinoma has been proposed.

Click here to see a similar case in an elderly man with prostate cancer, similarly without cardiac disease.

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The text is entirely the opinion of the author and does not necessarily reflect that of RUH NHS Trust or the Bristol Radiology Training Scheme. Website content devised by Paul McCoubrie.