LEARN NUCLEAR MEDICINE
Musculoskeletal · Case 08
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IMAGE PLACEHOLDER · Diagnostic study
Original study · Companion image placeholders
Clinical history
A 65-year-old woman with ESRD gets a bone scan to evaluate ulcerating soft tissue lesions.
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Calciphylaxis
Imaging Findings
Diffusely increased uptake within the bilateral inner thighs.
Diferential Diagnosis
Warfarin associated skin necrosis
Cholesterol embolization
Antiphospholipid syndrome
Essential Facts
Calciphylaxis consists of vascular calcification, thrombosis and cutaneous necrosis, preferentially affecting the lower extremities.
The pathogenesis remains unclear, however it consists of intravascular calcium deposition. This disease is predominantly seen in patients with end-stage renal disease (ESRD).
Scan Information
Bone scintigraphy is highly sensitive and specific for the diagnosis of calciphylaxis. It is useful in early diagnosis. An increase in heterogeneous radiotracer uptake within soft tissues throughout the body, with a preference for areas corresponding to clinical findings can be noted. It can also be used to monitor treatment response, as successful treatment completion will show a diffusely decreased skin uptake. The widespread radiotracer uptake seen in calciphylaxis helps differentiate it from inflammatory conditions, such as cellulitis, in which radiotracer uptake is localized to a discrete area.
References
https://drive.google.com/drive/folders/1pEEBm7ePE6APW–94IDH-ggpLzFWiRTz
Muzio, B. D. (n.d.). Calciphylaxis: Radiology Reference Article. Retrieved June 17, 2020, from https://radiopaedia.org/articles/calciphylaxis?lang=us
Paul, Suchismita. “Role of Bone Scintigraphy in the Diagnosis of Calciphylaxis.” JAMA Dermatology, American Medical Association, 1 Jan. 2017, jamanetwork.com/journals/jamadermatology/fullarticle/2475003.