Rapid Changes in the Scintigraphic Pattern in Tc-99m DPD Whole-Body Scanning in Metabolic Bone Disease

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The author describes a patient with generalized bone pain with metabolic bone disease who was erroneously diagnosed as having metastatic disease. The teaching points of this case include 1) the rapid changes in the abnormalities in bone scintigraphy in untreated osteomalacia; 2) the discrepancy between the normal appearance of the spine and severe lesions in other bones in metabolic bone disease, which could be used as a decision tool for the differential diagnosis; and finally 3) the necessity to correlate target lesions in bone scanning with conventional radiography even in patients with a high suspicion for generalized metastatic disease.

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