Asymmetrically increased rib cage uptake on bone scintigraphy: Incidental detection of pleural mesothelioma on single photon emission computed tomography/computed tomography

Our plain-English summary of Asymmetrically increased rib cage uptake on bone scintigraphy: Incidental detection of pleural mesothelioma on single photon emission computed tomography/computed tomography, by V.S. Dhull, P. Sharma, P. Durgapal, et al (Indian Journal of Nuclear Medicine, 2014).

The study

• Authors: V.S. Dhull, P. Sharma, P. Durgapal, S. Karunanithi, M. Tripathi, R. Kumar
• Journal: Indian Journal of Nuclear Medicine
• Published: 2014;29(1):43-5
• Type of article: Case report
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Follow-up bone scintigraphy (BS) in a patient of carcinoma left breast, who was treated with surgery followed by radiotherapy 12 years back, revealed asymmetrically increased radiotracer uptake in left-sided ribs. Since, this pattern was atypical for metastatic rib involvement, single photon emission computed tomography/computed tomography (SPECT/CT) of thorax was done in the same setting which revealed circumferential nodular left-sided pleural thickening. Biopsy confirmed it to be pleural mesothelioma. Left-sided ribs showed no abnormality on CT, thus suggesting the rib uptake as reactive in nature. This pattern of asymmetric rib uptake on BS should be kept in mind and warrants further investigation for determining underlying pathology.

In plain English

This was a case report of one patient from the All India Institute of Medical Sciences, New Delhi. A 50-year-old woman, treated 12 years earlier for left breast cancer with modified radical mastectomy and radiotherapy, had 3 months of left-sided chest pain. A bone scan to look for cancer spread showed diffusely increased tracer uptake in all left-sided ribs. Because this pattern was unusual for rib metastasis, SPECT/CT of the chest was done. The ribs looked normal on CT, but the left pleura showed circumferential nodular thickening, and the rib uptake was interpreted as reactive. A biopsy of the pleural lesion was suggestive of pleural mesothelioma. The patient had no other relevant history such as environmental or occupational exposure, and the authors hypothesized that the earlier radiotherapy could have played a role. The authors concluded that one-sided rib uptake on a bone scan should be kept in mind as an indirect sign of pleural disease warranting further investigation. A case report describes one person and does not show how often this happens.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient)
• Who was studied: One 50-year-old female patient with carcinoma of the left breast, treated with modified radical mastectomy and radiotherapy 12 years earlier, who presented with 3 months of left-sided chest pain; seen at the All India Institute of Medical Sciences, New Delhi
• Exposure: Radiotherapy given 12 years earlier for left breast cancer. The authors report no other relevant history such as environmental or occupational exposure. No asbestos exposure is described for this patient.
• Main results:
  • The bone scan (99mTc-MDP) showed diffusely increased radiotracer uptake in all the left-sided ribs. The rest of the skeleton was normal.
  • On CT bone window, the left-sided ribs had regular cortical outlines with no apparent abnormality.
  • CT in soft tissue window showed circumferential nodular left-sided pleural thickening.
  • The increased rib uptake was considered likely due to increased vascularity from the underlying pleural disease and was interpreted as reactive.
  • Biopsy of the pleural-based nodular lesion was suggestive of pleural mesothelioma (calretinin positivity was described as suggestive of malignant pleural mesothelioma).
  • With no environmental or occupational exposure in the history, the authors hypothesized that radiotherapy for the breast cancer could have played a role in the mesothelioma.
• The authors' conclusion: The authors concluded that asymmetrical one-sided rib cage uptake on a bone scan should be kept in mind as an indirect indicator of underlying pleural involvement, warranting further investigation.

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Carcinoma, Thorax, Pleural Thickening, Biopsy, Pathology.

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