Ascites detected on a whole-body bone scan

Overview

66-y-old lady suffering from an abdominal pain was admitted to our surgery department. She cooperated; she was afebrile, without dyspnea or icterus. She lost her apetite, but she did not lose her weight. She had a history of hypertension; diabetes compensated with oral antidiabetics and compensated hypothyroidism, but no cancer history. Physical examination was normal except for obesity. Chest X-ray was negative, abdominal ultrasound revealed a gallbladder stone and was highly suggestive for liver cirrhosis with an ascites. Subsequently performed gastroscopy disclosed a hiatal hernia and an ulcer on the large curvature with mucosal infiltration; nevertheless, biopsy did not prove a malignancy. Gynecological work-up including sonography was also unremarkable. Unenhanced abdominal CT confirmed a large volume of ascitic fluid (it was drained 8600 ml of sanguinolent fluid finally) and omental tumor infiltration. Laboratory investigations revealed tumor markers elevation; there were increased levels of CA 19-9 (123.4 kIU/l), CA 125 (93.2 kIU/l), HE 4 (544 pmol/l), and ROMA score (74.3 %; it serves as an estimate of epithelial ovarian cancer; it is based on CA 125 and HE 4 levels and menopause status); CEA was negative. Bone scan was performed as a part of a diagnostic work-up of a malignancy of an unknown primary. Whole-body bone scan was performed three hours post injection of 800 MBq of ^99mTc-HDP using a gamma camera BrightView XCT (Philips). Diffusely increased extra osseous accumulation in the whole abdominal cavity was detected besides physiological accumulation in the axial skeleton and large joints. (Fig. 1) Patient developed and acute renal failure with a progressive electrolytes imbalance; she died within four weeks after an admission (from cardiopulmonary failure).  Primary tumor was not detected, so oncological therapy was not provided; necropsy was not performed.

Keywords:

bone scan – tumorous ascites