Case Report
Volume: 4 | Issue: 10 | Published: Oct 28, 2020 | Pages: 343 - 346 | DOI: 10.24911/ejmcr/173-1588736309
Avascular necrosis of head of femur mimicking skeletal metastasis on 99mTc MDP bone scintigraphy - a rare case report
Authors: Muhammad Iqbal , Muhammad Naeem , Zahra Ahmed , Syeda Hadia Najam , Muhammad Shahzad Afzal , Muhammad Babar Imran
Article Info
Authors
Muhammad Iqbal
Department of Nuclear Medicine, PINUM Cancer Hospital, Faisalabad, Pakistan
Muhammad Naeem
Department of Surgery, PINUM Cancer Hospital, Faisalabad, Pakistan
Zahra Ahmed
Department of Nuclear Medicine, PINUM Cancer Hospital, Faisalabad, Pakistan
Syeda Hadia Najam
Department of Nuclear Medicine, PINUM Cancer Hospital, Faisalabad, Pakistan
Muhammad Shahzad Afzal
Department of Nuclear Medicine, PINUM Cancer Hospital, Faisalabad, Pakistan
Muhammad Babar Imran
Department of Nuclear Medicine, PINUM Cancer Hospital, Faisalabad, Pakistan
Publication History
Received: May 06, 2020
Accepted: July 01, 2020
Published: October 28, 2020
Abstract
Background: 99mTc-Methylene diphosphonate (MDP) bone scan of a patient with known breast carcinoma showed a solitary osteoblastic lesion in the femoral head. Solitary bone metastatic lesion and a benign cause-like remodeling phase of avascular necrosis (AVN) were the top most differential diagnoses and therefore can easily be misinterpreted for each other. Magnetic resonance imaging (MRI) is considered as the gold standard for diagnosis of AVN and can help in differentiation between AVN and skeletal metastasis. Case Presentation: A 40-year-old female patient of right breast carcinoma, treated with mastectomy, chemotherapy, and radiotherapy underwent 99mTc-MDP bone scintigraphy for pain in left hip with restricted movements. The bone scan showed focal uptake in the head of left femur with suspicion of AVN, which turned out to be a metastatic lesion on MRI. Later on, longitudinal follow-up of bone scan after 1 year showed a lesion in the left femoral head extending up to the trochanteric region with additional new lesions confirming skeletal metastasis. Conclusion: Solitary skeletal metastatic lesion in the head of femur is a rare finding, although in the presence of local symptoms AVN always remains at the top of the list for differential diagnosis of solitary osteoblastic focus in the femoral head. Bone scan is a primary tool for skeletal metastatic survey due to high sensitivity but due to low pathognomonic specificity, additional imaging with MRI must be considered as a safe, non-invasive, and easily available option for further characterization of solitary lesions.
Keywords: 99mTc-MDP bone scan, AVN, bone metastasis, MRI, case report, green
Pubmed Style
Muhammad Iqbal, Muhammad Naeem, Zahra Ahmed, Syeda Hadia Najam, Muhammad Shahzad Afzal, Muhammad Babar Imran. Avascular necrosis of head of femur mimicking skeletal metastasis on 99mTc MDP bone scintigraphy - a rare case report. EJMCR. 2020; 28 (October 2020): 343-346. doi:10.24911/ejmcr/173-1588736309
Web Style
Muhammad Iqbal, Muhammad Naeem, Zahra Ahmed, Syeda Hadia Najam, Muhammad Shahzad Afzal, Muhammad Babar Imran. Avascular necrosis of head of femur mimicking skeletal metastasis on 99mTc MDP bone scintigraphy - a rare case report. https://ejmcr.com/articles/1384 [Access: December 25, 2024]. doi:10.24911/ejmcr/173-1588736309
AMA (American Medical Association) Style
Muhammad Iqbal, Muhammad Naeem, Zahra Ahmed, Syeda Hadia Najam, Muhammad Shahzad Afzal, Muhammad Babar Imran. Avascular necrosis of head of femur mimicking skeletal metastasis on 99mTc MDP bone scintigraphy - a rare case report. EJMCR. 2020; 28 (October 2020): 343-346. doi:10.24911/ejmcr/173-1588736309
Vancouver/ICMJE Style
Muhammad Iqbal, Muhammad Naeem, Zahra Ahmed, Syeda Hadia Najam, Muhammad Shahzad Afzal, Muhammad Babar Imran. Avascular necrosis of head of femur mimicking skeletal metastasis on 99mTc MDP bone scintigraphy - a rare case report. EJMCR. (2020), [cited December 25, 2024]; 28 (October 2020): 343-346. doi:10.24911/ejmcr/173-1588736309
Harvard Style
Muhammad Iqbal, Muhammad Naeem, Zahra Ahmed, Syeda Hadia Najam, Muhammad Shahzad Afzal, Muhammad Babar Imran (2020) Avascular necrosis of head of femur mimicking skeletal metastasis on 99mTc MDP bone scintigraphy - a rare case report. EJMCR, 28 (October 2020): 343-346. doi:10.24911/ejmcr/173-1588736309
Chicago Style
Muhammad Iqbal, Muhammad Naeem, Zahra Ahmed, Syeda Hadia Najam, Muhammad Shahzad Afzal, Muhammad Babar Imran. "Avascular necrosis of head of femur mimicking skeletal metastasis on 99mTc MDP bone scintigraphy - a rare case report." 28 (2020), 343-346. doi:10.24911/ejmcr/173-1588736309
MLA (The Modern Language Association) Style
Muhammad Iqbal, Muhammad Naeem, Zahra Ahmed, Syeda Hadia Najam, Muhammad Shahzad Afzal, Muhammad Babar Imran. "Avascular necrosis of head of femur mimicking skeletal metastasis on 99mTc MDP bone scintigraphy - a rare case report." 28.October 2020 (2020), 343-346. Print. doi:10.24911/ejmcr/173-1588736309
APA (American Psychological Association) Style
Muhammad Iqbal, Muhammad Naeem, Zahra Ahmed, Syeda Hadia Najam, Muhammad Shahzad Afzal, Muhammad Babar Imran (2020) Avascular necrosis of head of femur mimicking skeletal metastasis on 99mTc MDP bone scintigraphy - a rare case report. , 28 (October 2020), 343-346. doi:10.24911/ejmcr/173-1588736309