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HISTORY:
The patient returns to clinic today
after a left mastectomy in 1992 for an infiltrating breast cancer with
1 of 10 positive lymph nodes. She was treated with the SWOG
chemotherapy regimen and is currently taking tamoxifen. She had
a right biopsy later in 1993 for lipoma, and she has no specific
complaints today, although on review of systems, she complains of her
bones hurting for the last 3 months. She has some spinal tenderness.
In the hollows of her eyes, it looks like she has lost quite a bit of
weight, although the pupils are normal, and the cranial nerves II
through XII were intact. She is not icteric, but she has a sallow
color to her skin. Respirations are clear, and they are normal rate
and unlabored, and pulse is normal times 4. Extremities are normal
times 4 without lymphedema. She has shotty bilateral neck nodes, and
then quite significant spinal tenderness even when she lays down.
On mammogram, the right, there is no evidence of change at BIRAD 2,
and just needs annual followup for that. I am quite concerned from her
physical exam that she has metastatic disease, and I had set her up
for a chest x-ray where she did not show any specific lesions, but
also set her up for a bone scan and metastatic workup which included a
chest X-ray and CT of the head, chest and pelvis which were negative
for metastatic disease.
WHOLE BODY BONE SCAN (Sept 2004)
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Click to see magnified image |
Compared to prior study dated 10-21-98.
INDICATION: 56 year-old black female with history of breast carcinoma.
Following intravenous administration of 23 millicuries of Technetium
99M HDP, anterior and posterior whole body images were obtained at 2
hour delay.
FINDINGS: There is some increased activity seen in the thyroid
cartilage. There is also some increased activity seen in the shoulders
and in the left lateral aspect of the L4-5 level consistent with
degenerative change. There is also increased activity seen in the
renal cortex and physiologica activity seen in the bladder. There are
no focal areas of increased or decreased activity within the skeleton
to suggest metastasis.
IMPRESSION:
1. INCREASED ACTIVITY SEEN IN THE RENAL
CORTEX WHICH MOST LIKELY RELATED TO RENOTOXIC CHEMOTHERAPY AND
RECOMMEND CLINICAL CORRELATION.
2. DEGENERATIVE CHANGES IN THE SHOULDERS AND AT THE L4-5 LEVEL AS
DESCRIBED ABOVE.
BACK
© 2004 Nuclear Education Online
- Images courtesy of University
of Arkansas for Medical Sciences Dept of Nuclear Medicine.
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