Diffused Pulmonary Uptake of Tc-99m Methylene Diphosphonate Bone Scan in Patient with Prostate Cancer without Blood Test and Correlative/Cross-Sectional Imaging Abnormalities: A Case Report

Junan Imaniar, Minseok Suh, Ayu Rosemeilia Dewi, Yustia Tuti


Introduction: Bone scan using Tc-99m methylene diphosphonate (MDP) is a commonly used procedure for evaluating bone metastasis in cancer patients. Extra-osseous pulmonary uptake in bone scans is mostly an incidental finding and occurs in a multitude of disorders. Clinicians should be alert to any findings on clinical or complementary diagnostic tools. We presented a case of prostate cancer male patients who demonstrated diffuse pulmonary uptake on Tc-99m MDP bone scan without any blood test and correlative/cross-sectional imaging abnormality


Case Presentation: An 80-year-old male with adenocarcinoma of the prostate with a Gleason score of 6 (3+3). The PSA level was 0.009. The patient had a history of recurrent atrial fibrillation (AF), postural dizziness, HTN, Gout, and chronic renal failure, but all of these comorbidities were under control. The patient underwent a bone scan to annually check for the presence of bone metastases. Three hours after administering 740 MBq Tc-99m MDP intravenously. The reports didn’t show any increased uptake that would indicate metastases in the bones. Instead, diffuse bilateral pulmonary uptake and a mild increase in cardiac uptake were present. On the same day, a computed tomography (CT) scan of the thorax revealed 3 micro-nodules in the right upper lung that were described as benign lesions, and a chest X-ray confirmed normal results. The patient’s laboratory results were within normal range, and there were no clinical lung symptoms or complaints. Considering the patient history of persistent AF, chronic renal failure, and a complaint of postural dizziness, the bone scan finding may indicate involvement of amyloidosis. The relationship between amyloidosis and cancer was also widely noted.


Conclusions: Tc-99m MDP may play a role in evaluating amyloidosis involvement in an uncommon place such as the lungs. Future research should focus on analyzing diagnostic options in the patient’s condition in this situation.


Keywords: cancer, diffused pulmonary uptake, amyloidosis, bone scan


amyloidosis, bone scan, cancer, diffused pulmonary uptake

Full Text: View | Download

DOI: 10.33371/ijoc.v18i1.1063

Article Metrics

Abstract View: 229,
PDF Download: 71


O'Malley JP, Ziessman HA, Thrall JH. Nuclear Medicine and Molecular Imaging: The Requisites E-Book. Elsevier Health Sciences; 2020.

Kwon HW, Chung JK, Ab-Aziz A, Lee DS. Diffuse Pulmonary Uptake of Tc-99m Methylene Diphosphonate in a Patient with Non-tuberculosis Mycobacterial Infection. Nucl Med Mol Imaging. 2010;44(2):146-9.

Eberle MC, Fersing C, Guillemard S, et al. Unusual Focal Lung Uptake without CT Abnormality on a Bone Scan: What Might It Mean? Diagnostics (Basel). 2022;12(4).

Fallahi B, Ghafary BM, Fard-Esfahani A, Eftekhari M. Diffuse pulmonary uptake of bone-seeking radiotracer in bone scintigraphy of a rare case of pulmonary alveolar microlithiasis. Indian J Nucl Med. 2015;30(3):277-9.

Sellem A, Ajmi WE, Mahjoub Y, Hammami H. Pulmonary calcification in renal failure patient incidentally revealed by bone scintigraphy. Indian J Nucl Med. 2015;30(3):275-6.

Bach-Gansmo T, Wien TN, Londalen A, Halvorsen E. Myocardial uptake of bone scintigraphic agents associated with increased pulmonary uptake. Clin Physiol Funct Imaging. 2016;36(3):237-41.

Paudel J, Singh H, Sood A, et al. Serendipitous Detection of Extraosseous Metastases on Bone Scintigraphy: Utility of Cross-sectional and Correlative Imaging. World J Nucl Med. 2017;16(4):331-3.

Krishnappa D, Dykoski R, Can I, et al. Atrial Fibrillation in the Elderly: The Role of Sub-Clinical Isolated Cardiac Amyloidosis. Sci Rep. 2019;9(1):16584.

Dorbala S, Ando Y, Bokhari S, et al. ASNC/AHA/ASE/EANM/HFSA/ISA/SCMR/SNMMI Expert Consensus Recommendations for Multimodality Imaging in Cardiac Amyloidosis: Part 2 of 2-Diagnostic Criteria and Appropriate Utilization. J Card Fail. 2019;25(11):854-65.

Velayati S, Belkin A, Sidhu Kumar G, et al. Kidney-limited AL amyloidosis: a case report and review of the literature. J Community Hosp Intern Med Perspect. 2021;11(5):698-702.

Cappelli F, Gallini C, Costanzo EN, et al. Lung uptake during 99mTc-hydroxymethylene diphosphonate scintigraphy in patient with TTR cardiac amyloidosis: An underestimated phenomenon. Int J Cardiol. 2018;254:346-50.

Sachchithanantham S, Hutt DF, Quigley AM, et al. Role of (99m) Tc-DPD scintigraphy in imaging extra-cardiac light chain (AL) amyloidosis. Br J Haematol. 2018;183(3):506-9.

Natsume S, Nakahara Y, Okamura T, Hishima T. Pulmonary amyloidosis mimicking prostate cancer metastasis. Clin Case Rep. 2015;3(7):626-8.


  • There are currently no refbacks.

Copyright (c) 2024 Junan Imaniar, Minseok Suh, Ayu Rosemeilia Dewi, Yustia Tuti

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.