LEARN NUCLEAR MEDICINE
Musculoskeletal · Case 09
Read the history, inspect the study, then reveal the teaching.
IMAGE PLACEHOLDER · Diagnostic study
Original study · Companion image placeholders
Clinical history
A 40-year-old female is brought to the ED after a motor vehicle collision. The woman was trapped in the car for 30 minutes. There is evidence of blunt trauma, but no obvious penetrating injury. Lab values are significant for an increase in serum CK. Her bone scan is provided below.
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Read the images before opening the teaching panel below.
Rhabdomyolysis
Imaging Findings
Marked extraosseous tracer uptake in the left pectoralis major, interspinal muscles, and gluteal muscles.
Essential Facts
Rhabdomyolysis is a muscle injury commonly associated with trauma, exposure to certain medications, or prolonged immobilization from substance abuse. The release of large quantities of toxic intracellular contents into the blood from the breakdown of muscle can damage the kidneys, resulting in acute renal failure.
Rhabdomyolysis frequently presents with muscle pain and weakness, dark urine, and an increase in serum creatine kinase (CK). Aggressive IV hydration to prevent renal injury, and correction of electrolyte abnormalities is critical.
Scan Information
Rhabdomyolysis can be identified on whole body bone scan as extraosseous Tc99m-MDP tracer uptake. Bone scans remain a valuable screening modality for detecting muscle damage within the entire body. While a diffuse, systemic uptake may indicate an underlying metabolic muscle disorder, focal uptake should increase suspicion of trauma. It can also be used as a systemic follow up tool by continuing to provide estimates of the severity of an acute case of rhabdomyolysis, pre and post treatment.
References
Nuclear Medicine Case Review Series, by Harvey A. Ziessman, Elsevier, 2011, p. 133-134.
https://drive.google.com/drive/folders/1KsSGxRufvR3DHpqh3IzcyCQx_X1-Qs3m