Extraosseous uptake of technetium-99m methylene diphosphonate by an acute territorial cerebral infarct in a classical biodistribution pattern
A 77-year-old woman was referred for Tc-99m MDP whole body nuclear bone scan to rule out metastases. She underwent bilateral mastectomy 3 years ago for bilateral breast carcinoma and received chemotherapy also. She had multiple comorbidities including diabetes mellitus, hypertension and hypercholesterolemia and was bed-ridden, due to her chronic debilitated status.\nIn the anterior and posterior images of the whole body bone scan, a normal physiological pattern of tracer uptake was observed in the bones and degenerative changes were observed in bilateral shoulders, left knee and left ankle. No focus of intense uptake of tracer in bones suspicious of metastases was identified in axial and appendicular skeleton []. However, a heterogeneous and diffuse tracer uptake was noted in the right hemicranium and following which spot films of skull lateral views were obtained. The distribution of tracer uptake in the right lateral view of skull corresponded with the anterior circulation territory of the brain, sparing the posterior circulation territory of posterior fossa with a sharp demarcation []. Since the finding raised a strong suspicion of right anterior circulation territorial infarct of brain, patient was subjected to clinical examination, which revealed that the power of the left lower and upper limbs were reduced when compared to the right side.\nPatient was referred to the intensive care unit immediately for acute medical care. Later, patient was further investigated with magnetic resonance imaging (MRI), which confirmed the presence of an acute cerebral infarct confined to the right internal carotid arterial territory [Figure –]. Patient was discharged after conservative management.