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Case Report
The Open Access Journal of Science and Technology
Vol. 2 (2014), Article ID 101066, 2 pages
doi:10.11131/2014/101066

Displaced Kidney Simulating a Pelvic Mass on Bone Scintigraphy

Muhammad Shah, Raphaella Da Silva, Hong Ma, Changping Jia, and Leonard M. Freeman

Division of Nuclear Medicine, Department of Radiology, Montefiore Medical Center and the Albert Einstein College of Medicine of Yeshiva University, Bronx, New York, USA

Received 18 December 2013; Accepted 20 July 2014

Academic Editors: Mohamed Jarraya, Po-Hsiang Tsui, and Giorgio Treglia

Copyright © 2014 Muhammad Shah et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Pelvic kidney is a common renal ectopy and can present a diagnostic challenge on bone scintigraphay. We present a case of a 48 year old female with breast cancer who was found to have an intense focus of MDP uptake anterior to the lower lumbar spine on planar bone scintigraphy. An abdominal CT later demonstrated that a large liver cyst is displacing the kidney infero-medially into the pelvis.

Radionuclide bone scintigraphy is a commonly employed procedure to detect suspected bone metastases in a variety of cancers [1,2]. It is also used for the investigation of many benign musculoskeletal conditions [1,2]. Bone scans are very sensitive, but less specific. In order to increase the specificity, it is important to reduce misinterpretation with a comprehensive knowledge of and experience with normal variants and the other patterns, which may mimic metastases or other musculoskeletal pathology [2,3,4,5,6]. Pelvic kidney is the most common type of renal ectopy, with an incidence of 1 in 500 to 1 in 2000 cases and can present a diagnostic challenge in interpreting a bone scan [7]. The pelvic kidney is usually a unilateral phenomenon, and located in the true pelvis, and can mimic a tumor or possible metastatic focus on planar imaging that may require further delineation (as in this case) with additional diagnostic imaging [8,9].

F1
Figure 1: Planar bone scintigraphic images showing intense uptake anterior to the lower lumbar spine mimicking a midline metastasis in this patient with breast cancer (white arrows in A, B). Note is also made of a “missing” right kidney and a relatively photon deficient right hemi-abdomen (bold arrow in A). An abdominal CT scan subsequently demonstrated a midline pelvic kidney in the lower lumbar region (arrow in C) as well as a large liver cyst (arrow in D) causing displacement of the right kidney from its normal position infero-medially into the pelvis.

References

  1. G. Gnanasegaran, G. Cook, K. Adamson, and I. Fogelman, Patterns, Variants, Artifacts, and Pitfalls in Conventional Radionuclide Bone Imaging and SPECT/CT, Seminars in Nuclear Medicine, 39, no. 6, 380–395, (2009). Publisher Full Text | Google Scholar
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  3. G. Storey, Murray IPC: Bone scintigraphy: The procedure and interpretation, in Ell PJ, Gambhir SS: Nuclear Medicine in Clinical Diagnosis and Treatment, in Churchill Livingstone, Elsevier, New York, 1, 593–622, 2004.
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  7. A. A. Bader, K. F. Tamussino, and R. Winter, Ectopic (pelvic) kidney mimicking bulky lymph nodes at pelvic lymphadenectomy, Gynecologic Oncology, 96, no. 3, 873–875, (2005). Publisher Full Text | Google Scholar
  8. G. W. Friedland, P. A. Deveries, M. Nino-Murica, et al., Congenital anomalies of the kidney, In Pollack H. M. (ed), 578–653, Clinical urography, Philadelphia, 1990, WB Saunders.
  9. S. B. Bauer, Anomalies of the upper urinary tract. In Walsh PC (ed): Campbell’s urology. 8th ed. Philadelphia, WB Saunders, 1885–1924, 2002.
Case Report
The Open Access Journal of Science and Technology
Vol. 2 (2014), Article ID 101066, 2 pages
doi:10.11131/2014/101066

Displaced Kidney Simulating a Pelvic Mass on Bone Scintigraphy

Muhammad Shah, Raphaella Da Silva, Hong Ma, Changping Jia, and Leonard M. Freeman

Division of Nuclear Medicine, Department of Radiology, Montefiore Medical Center and the Albert Einstein College of Medicine of Yeshiva University, Bronx, New York, USA

Received 18 December 2013; Accepted 20 July 2014

Academic Editors: Mohamed Jarraya, Po-Hsiang Tsui, and Giorgio Treglia

Copyright © 2014 Muhammad Shah et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Pelvic kidney is a common renal ectopy and can present a diagnostic challenge on bone scintigraphay. We present a case of a 48 year old female with breast cancer who was found to have an intense focus of MDP uptake anterior to the lower lumbar spine on planar bone scintigraphy. An abdominal CT later demonstrated that a large liver cyst is displacing the kidney infero-medially into the pelvis.