unusual presentation, pilomatrixoma in the buttock area - a case report

Pilomatrixoma is benign tumor of skin appendages it is rare tumor mainly involving head, neck face and upper extremities. 1 A 16-year-old male developed a lesion, over a period of 2 year, at the middle of right buttock. The presumed diagnosis was a sebaceous cyst / pyogenic granuloma. An excision biopsy was performed and the histopathologic diagnosis was a pilomatrixoma

Diffuse lung uptake on [99m]Tc-MDP bone scintigraphy-case report

A [99m]Tc-methylene diphosphate [MDP] bone scan of a 35 years old female patient performed for possible skeletal metastasis from carcinoma breast. Diffuse [99m]Tc-MDP uptake was seen in both the lung fields on [99m]Tc-MDP bone scintigraphy. Biochemical and radiological evaluation excluded all the known causes of the diffuse [99m]Tc-MDP lung uptake. Raised serum ferritin levels of 1226ng/ml [normal range for adult female = 13 - 15 ng/ml] was the only abnormal biochemical finding and attributed as the possible cause of lung uptake

Radionuclide gastroesophageal reflux scan; an effective screening tool for infants/children with repeated chest infections

Objective: unexplained recurrent chest infections are a cause of failure to thrive in infants and young children. Repeated hospital admissions with respiratory symptoms are an extra economic burden on the health budget along with the morbidity. The aim of this study was to analyze the utility of Nuclear Medicine to screen children with clinically significant gastroesophageal reflux

Design and Place of Study: this study was descriptive case series and was conducted at Punjab Institute of Nuclear Medicine in collaboration with the department of pediatrics Allied Hospital Faisalabad

Patients and Methods: seventy clinically symptomatic patients underwent Gastroesophageal Reflux [GER] Scan with effective fasting of one to three hours. Four to thirty seven MBq of [99m]Tc labeled Colloid was diluted in milk for oral intake. Thirty minutes dynamic study with frame rate of 3 second per frame was acquired in either anterior or posterior projection. Both qualitative and quantitative analysis was done using cine review, time active curves [TAC] and percentage reflux index [%RI]. Patients with high grades of reflux were also reviewed after 08 weeks of conventional antireflux treatment

Results: sixty three percent of the patients [44/70] were declared as reflux positive of varying grades on GER scan. Most of the refluxing subjects [26/44] were in grade I/II category while [13/44] of the patient showed moderate degree reflux and only [2/44] of the patients fell into severe reflux category. Chest infection was the chief clinical presentation in each grade of reflux [57%]. Of all the refluxing individuals, [9/44] were having no refluxing spikes on TACs while when reflux index [%RI] were calculated [4/44] of the patients showed value below 4%. Eighty percent of selected patients [8/10] showed improvement with conventional antireflux treatment but complete improvement was evident only in [3/10] patients

Conclusion: GER scan is a non-invasive and effective way of screening clinically symptomatic babies for reflux of the gastric contents interfering with the respiratory tract. Quantitative assessment of improvement after conventional antireflux treatment offer cost-effective follows up of GERD

Pattern of distribution of metastatic lesions within skeleton in patients with breast carcinoma of Faisalabad and its vicinity

Evaluation of pattern of distribution of skeletal metastases in patients with breast carcinoma. by using [99m]Tc MDP Skeletal Scintigraphy. Retrospective Analysis. Study was conducted at Punjab Institute of Nuclear Medicine [PINUM], Faisalabad Pakistan from January 2006 to June 2009. A retrospective study was performed on 465 consecutive patients having CA Breast irrespective of preoperative/postoperative status, presenting for bone scan at Punjab Institute of Nuclear Medicine. Whole body bone scan was performed, along with additional spot views, where needed. The images were interpreted for metastatic deposits by three independent observers. Where needed, plain X-ray was performed to correlate in favor of benign pathology. Out of 465 patients [453 female and 12 Male], 286 [62%] patients were having either normal bone scan or some benign pathology as correlated with plain x-ray of the suspected area. 179 [38%] patients were positive for metastases within skeleton. Among these, 61.4% patients were having multiple, 14% with two, while 24.6% were diagnosed as having solitary lesions within the skeleton. In patients having multiple skeletal lesions, highest number was noted in spine [84.5%- most common in thoracolumbar], followed by ribs [55.5%], pelvis [37.3%---most frequent in iliac bone], skull [32%], scapula [27.3%], sternum [26.4%], femur [19.1%], humerus [14.5%], clavicle [3.6%] and tibia [0.9%]. In humerus and femur, most lesions were located in their upper ends, followed by shafts. Right side of skeleton was more frequently involved than the left. In patients having lesions in ribs and pelvis, most of the lesions were bilateral. Patients with two lesions showed maximum number of lesions in rib cage [44%], followed by spine [32%-all being in thoracolumbar region], scapula [24%], pelvis and scapula [24% in each], sternum [16%], skull [8%], humerous and femur [4% in each]. In patients having solitary focal lesion, highest number was noted in spine [45.5%-most common in thoracolumbar spine], followed by ribs [22.7%], sternum and pelvis [13.6% each], and skull [6.8%]. No lesion was noted in appendicular skeleton. Multiple skeletal metastases are much more common than solitary or two lesions in cases of known breast carcinoma. Axial skeleton including skull is most commonly involved. Spine [especially thoracolumbar] is the most frequent site of involvement followed by rib cage, pelvis and then skull. In peripheral bones, most frequent site is the upper end of femur followed by humerus