Serendipity and Bone Scintigraphy

Abstract

A 59-year-old man was admitted with low back pain. Radiographs of the lumbosacral spine revealed compression fractures at L1 and L2. A myelogram showed a partial block at the same level. A bone scan demonstrated abnormal focal areas of increased uptake in the region of T12, L1, and L2 and nonvisualization of the left kidney. Therefore, a renal scan was obtained and revealed an abnormal focus of radionuclide accumulation during the angiographic phase of the study, suggestive of an abdominal aortic aneurysm with absent perfusion and function of the left kidney. The arteriogram confirmed the presence of an abdominal aortic aneurysm with nonopacification of the left renal artery and left kidney. Subsequently, the patient was found to be in shock and was rushed to the operating room. At surgery, the aortic aneurysm was found to have ruptured, necessitating resection and graft placement. His postoperative course was complicated by systemic candidiasis, disseminated intravascular coagulation (DIC), adult respiratory distress coagulation (ARDS), and renal failure. He eventually died due to renal failure caused by diffuse bilateral renal infarcts secondary to aortic thrombosis. Although the outcome of this case is undesirable, it illustrates the capability of bone scintigraphy in serendipitously detecting urologic pathology.