Skeletal Imaging - positioning for a scapula lesion.
Clinical history: Female with a history of breast cancer. Bone scan requested to rule out metastases. Patient complained of left shoulder pain.
Technique: The patient received 25 mCi Tc MDP and whole body and spot shots were obtained at 3 hours post injection.
Findings: The study was compared to a previous bone scan acquired 1-year earlier. Findings demonstrate an area of increased uptake at the inferior angle of the left scapula. The finding was considered to be a stable metastatic lesion that was also seen on a CT and described as mixed sclerotic and lytic lesion.
No other abnormalities were noted..
Posterior whole body view shown.
Additional images were acquired in the left anterior oblique view, to demonstrate the lesion was truly in the scapula, not in the ribs. In this case the lesion still overlies the ribs making true determination difficult.
An additional posterior view was obtained with the patients arms raised over her head. This movement moves the scapula outward providing separation of the scapula from the posterior rib cage.
Excellent ! It's nice to use our thinking skills and knowledge of anatomy. It's not always a "routine" bone scan! Keep your eyes and mind open - Always give the radiologist a specific answer, not just "it could be ribs or it could be scapula".
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