Renal osteodystrophy presenting as a metabolic superscan on F-18 FDG PET/CT : a case report

Abstract

RATIONALE : F-18 Fluoro Deoxyglucose positron emission tomography and computed tomography (F-18 FDG PET/CT) is a useful modality in the evaluation of patients with malignancies. Increased incidence of lympho-proliferative disorders has been reported in individuals with long-standing end-stage renal disorders treated with renal replacement therapy. PATIENT CONCERNS : A 30-year-old male on peritoneal dialysis on account of end-stage renal disease. He had acute rejection of an earlier transplanted renal allograft. He was referred for an F-18 FDG PET/CT based on a clinical suspicion of lymphoma on account of bilateral inguinal lymphadenopathy associated with bilateral pedal swelling. DIAGNOSIS : Renal osteodystrophy was diagnosed based on diffusely intense F-18 FDG uptake in the axial skeleton, focal uptake in the costochondrial junctions and linear cortical uptake in the appendicular skeleton. No findings suggestive of lymphoma was seen. INTERVENTIONS : A diagnosis of renal osteodystrophy with no evidence of a lymphoma prevented futile biopsy of inguinal lymphadenopathy. Patient continued with peritoneal dialysis with no further intervention OUTCOMES : Regular follow-up of patient to monitor calcium, phosphate and parathyroid hormone levels. Treatment will be indicated when laboratory results as well as clinical signs and symptoms are suggestive. LESSON : Metabolic bone disorder such as is seen in renal osteodystrophy should be considered in the differential diagnoses in patients with diffusely increased bone uptake on F-18 FDG PET/CT scan. ABBREVIATIONS : CT = computed tomography, DOTANOC = 1-NaI3-octrotide 1,4,7,10-tetraazacyclododecane-N,N’,N”,N”’- tetraacetic acid, F-18 FDG = fluorine-18 2-fluoro-2-deoxyglucose, Ga-68 = gallium 68, HIV = human immunodeficiency virus, MDP = methylene diphosphonate, PET = positron emission tomography, PSMA = prostate specific membrane antigen, PTH = parathyroid hormone, Tc-99m = technetium 99 metastable.