European Journal of Nuclear Medicine

, Volume 11, Issue 1, pp 36–42 | Cite as

Diffuse pulmonary uptake of 99mTc bone-imaging agents: Case report and survey

  • Jean-Luc Coolens
  • Paul Devos
  • Michel De Roo
Case Reports


Over the past 5 years, we have encountered 6 cases of diffuse pulmonary uptake of 99m-Tc bone-scanning agents (incidence, 0.04%). To assess the significance of this phenomenon, we reviewed all of the cases reported since 1974 (Including our series, a total of 32 cases). Three groups can be discerned, the first consisting of 24 patients without radiological calcifications in the lungs and with hypercalcemia of different origins (mostly hyperparathyroidism). Of the eight autopsies performed in this group, seven revealed extensive calcifications in alveolar walls and lung vessels; the other autopsy showed no calcification at all and only bronchopneumonic lesions. The second group consists of 6 patients in chronic dialysis. The last group consists of 2 patients having diffuse pulmonary alveolar microlithiasis with extensive radiologic calcifications.

The mechanism of lung uptake of 99m-Tc bone-imaging agents is probably the same as that of bone uptake (chemisorption on hydroxyapatite crystals), although other uptake mechanisms have also been discussed.

Bone scintigraphy can be useful in the detection of early pulmonary calcifications, which have been associated with impaired pulmonary function and, due to their size, are generally not detected by X-ray.

Key words

99mTc bone-imaging agents extra skeletal uptake hypercalcemia 


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  1. Alfrey AC, Solomons C, Circillo J, Miller N (1976) Bone pyrophosphate in uremia and its association with extraosseous calcification. J Clin Invest 57:700–705Google Scholar
  2. Aprile C, Bernado G, Carena M, Farino A, Robustelli Della Cuna G, Strada MR, Mascherpa S (1978) Accumulation of 99m-Tc-Sn-pyrophosphate in pleural effusions. Eur J Nucl Med 3:219Google Scholar
  3. Bonte F, Parkey R, Graham K, Moore J, Stokely E (1974) A new method for radionuclide imaging of myocardial infarcts. Radiology 110:473–474Google Scholar
  4. Brown M, Swee R, Olson R, Bender C (1978) Pulmonary uptake of 99m-Tc diphosphonate in alveolar microlithiasis. Am J Roentgenol Radium Ther Nucl Med 131:703–704Google Scholar
  5. Conger J, Alfrey A (1976) Scanning for pulmonary calcifications. Ann Intern Med 84:224–225Google Scholar
  6. Curry SL (1979) Accumulation of 99m-Tc methylene diphosphonate in an adenocarcinoma of the lung. J Nucl Med 4:170–171Google Scholar
  7. Davis B, Poulose K, Rebax R (1976) Scanning for uremic pulmonary calcifications. Ann Intern Med 85:132Google Scholar
  8. De Graaf, P, Schicht I, Pauwels E, Souverijn J, De Graeff J (1979) Bone scintigraphy in uremic pulmonary calcifications. J Nucl Med 20:201–206Google Scholar
  9. Devacaanthan K, Yap A, Chayes Z, Stein R (1976) Pulmonary calcification in chronic renal failure: use of diphosphonate scintiscan as a diagnostic tool. Clin Nephrol 6:488–491Google Scholar
  10. Gatter RA, McCarty DJ (1967) Pathological tissue calcifications in men. Arch Pathol 84:346–353Google Scholar
  11. Stilson M (1974) Radionuclide detection of diffuse interstitial pulmonary calcification. JAMA 230:992–995Google Scholar
  12. Herry J, Chevet D, Moisan A, Lepogamp P, Le Jeune J, Kerdiles Y (1981) Pulmonary uptake of 99m-Tc labeled methylene diphosphonate in a patient with a parathyroid adenoma. J Nucl Med 22:888–890Google Scholar
  13. Itoh K, Furudata M (1979) Diffuse lung uptake on bone imaging in primary hyperparathyroidism before and after excision of a parathyroid adenoma. Clin Nucl Med 4:382–383Google Scholar
  14. Kleisbauer P, Padovani B, Pasqier J (1983) Fixation pulmonaire lors d'une scintigraphie osseuse au technetium. Presse Med 12:1369Google Scholar
  15. Lucas P, Amico S (1983) Fixation pulmonaire lors d'une scintigraphie osseuse au technetium. Presse Med 12:47–48Google Scholar
  16. McCartney W, Nusynowitz M, Reimann B, Prather J, Mazat B (1976) 99m-Tc diphosphonate uptake in neuroblastoma. Am J Roentgenol Radium Ther Nucl Med 126:1077–1081Google Scholar
  17. McLaughlin (1975) Uptake of 99m-Tc bone scanning agent by lungs with metastatic calcifications. J Nucl Med 16:322–329Google Scholar
  18. Moinuddin M, Rockett J, Weber A (1976) Scanning for pulmonary calcification. Ann Intern Med 84:224Google Scholar
  19. Ravin CE, Hoyt TS, Deblanc M (1977) Concentration of 99m-Technetium polyphosphate in fibrothorax following pneumonectomy. Radiology 122:405–408Google Scholar
  20. Richards A (1974) Metastatic calcification detected through scanning with 99m-Tc polyphosphate. J Nucl Med 15:1057–1060Google Scholar
  21. Richards A (1975) Radionuclide detection of metastatic calcification. JAMA 231:1339Google Scholar
  22. Rosenthal D, Chandler H, Azizi F, Schneider P (1977) Uptake of bone imaging agents by diffuse pulmonary metastatic calcification. Am J Roentgenol Radium Ther Nucl Med 129:871–874Google Scholar
  23. St. Goar W, Gallagher MJ (1976) Case records of the Massachusetts General Hospital: severe hypercalcemia with fulminant course in a 52 year old woman. N Engl J Med 295:433–440Google Scholar
  24. Sarreck R, Sham R, Alexander L, Cortez E (1979) Increased 99m-Tc pyrophosphate uptake with radiation pneumonitis. Clin Nucl Med 4:403–404Google Scholar
  25. Scarpellini M, Trotti G, Tosi F, Branchini L (1982) Pulmonary localization of phosphate bone agents in a case of metastatic breast carcinoma. Tumori 68:413–416Google Scholar
  26. Schalangen J, Pauwels E (1976) Die Diagnostik der calcinosis pulmonis durch szintigraphische Untersuchungen. ROFO 124:119–123Google Scholar
  27. Shigeno C, Fukunaga M, Morita R, Maeda H, Hino M, Torizuka K (1982) Bone scintigraphy in pulmonary alveolar microlithiasis: A comparative study of radioactivity and density distribution. Clin Nucl Med 7:103–107Google Scholar
  28. Valdez V, Jacobstein J, Perlmutter S, Brusman H (1979) Metastatic calcification in lungs and stomach demonstrated on bone scan in multiple myeloma. Clin Nucl Med 4:120–121Google Scholar
  29. Venkatesh N, Poleyn R, Norback D (1978) Metastatic calcification. The role of bone scanning. Radiology 129:755–758Google Scholar
  30. Watson N, Cowan R, Maynard C, Richards F (1977) Resolution of metastatic calcification revealed by bone scanning: case report. J Nucl Med 18:890–892Google Scholar
  31. Wraight E (1983) Focal lung uptake of 99m-Tc methylene diphosphonate associated with pulmonary emboli and hypercalcemia. Br J Radiol 56:345–347Google Scholar

Copyright information

© Springer-Verlag 1985

Authors and Affiliations

  • Jean-Luc Coolens
    • 1
  • Paul Devos
    • 1
  • Michel De Roo
    • 1
  1. 1.Department of Nuclear MedicineUniversitaire Ziekenhuizen, K.U. LeuvenLeuvenBelgium

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