Abstract
IntroductionProstate cancer is known to have a tendency to metastasize to bone. Skeletal scintigraphy can be used to show multiple lesions. Diffuse metastasis, which is not infrequent in prostate cancer, can also be suspected on the basis of a 'super scan'. However, this phenomenon in nuclear medicine has several other causes that need to be considered.Case presentationA patient with a history of prostate cancer presented with pleural fluid, peripheral edema and bone pain. A super scan of the bone was found which suggested diffuse skeletal metastasis of the prostate cancer but the patient also had a prostate specific antigen level which was not compatible with this diagnosis. Further investigations revealed the paraneoplastic phenomenon of hypertrophic osteoarthropathy, related to an incurable carcinoma of the lung, to be the cause of the super scan.ConclusionA super scan is characterized by a high bone to soft tissue ratio on skeletal scintigraphy, with a uniform symmetrical increase in bone uptake and diminished to absent renal visualization ('absent kidney sign'). It can be seen in a variety of diseases in which there is a diffusely increased bone turnover. Diffuse skeletal metastasis of a well-differentiated prostate carcinoma is unlikely to be the cause of a super scan when the prostate specific antigen level is not elevated. This is the first report of a super scan due to pulmonary hypertrophic osteoarthropathy which can be seen in lung carcinoma and other pulmonary diseases.
Highlights
Prostate cancer is known to have a tendency to metastasize to bone
Further investigations revealed the paraneoplastic phenomenon of hypertrophic osteoarthropathy, related to an incurable carcinoma of the lung, to be the cause of the super scan
A super scan is characterized by a high bone to soft tissue ratio on skeletal scintigraphy, with a uniform symmetrical increase in bone uptake and diminished to absent renal visualization ('absent kidney sign')
Summary
This case illustrates that a super scan of the bone is a distinct entity in nuclear medicine that can point towards several different bone disorders. Especially when well-differentiated with a low PSA level, skeletal metastasis is unlikely. As in this case, non-metastatic paraneoplastic, or even benign diagnoses should be considered. Non-metastatic paraneoplastic, or even benign diagnoses should be considered To our knowledge this is the first report of a super scan due to extensive HOA. In modern day medical practice, a clinician is often confronted with the results of several diagnostic modalities. It remains the task of the clinician to be critical and to interpret the different aspects and findings in relation to each other
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