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Findings: An intense focus of radiopharmaceutical over the right sacroiliac joint following thorough cleaning of urine contamination.

Diagnosis: Breast cancer without osseous metastasis.

Discussion: Shown are the anterior and posterior images from a routine total body bone scan for osseous metastases due to breast cancer using Technetium -99m-MDP. There is obvious urine contamination over the pelvis and lower extremities from incontinence. The subsequent images over the pelvis following thorough cleaning of the patient show a large focus of radiopharmaceutical projecting in the region of the right sacroiliac joint. Its appearance is typical of metastatic disease to bone. However, a focus of this intensity seen on the posterior view should also be visualized on the anterior view and it is not. This prompted additional lateral images of the pelvis which show contamination of the soft tissue posterior. We routinely check images before the patient is removed from the camera to solve problems such as this one. Had additional images not been obtained, an interpretation of osseous metastases or, at best, confusion as to the etiology of the activity would have occurred.

References:
Coel M, Leung J. Atlas of Nuclear Medicine. W. B. Saunders Company, 1996.

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