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Banana-like Appearance of Rib Fibrous Dysplasia in Bone Scintigraphy and Single-Photon Emission Computed Tomography (SPECT)
Address for correspondence: Dr. Mohd Hazeman Zakaria, Department of Radiology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor 43400, Malaysia. E-mail: hazeman@upm.edu.my
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Received: ,
Accepted: ,
This article was originally published by Wolters Kluwer - Medknow and was migrated to Scientific Scholar after the change of Publisher.
Abstract
The patient, a 37-year-old male, initially presented with per rectal bleed. Colonoscopy revealed a circumferential lesion within the lower rectum, along with a few satellite lesions. At that time, we performed a biopsy, but the histopathological examination revealed consistent solitary rectal ulcer syndrome. Subsequent bone scan revealed increased radiotracer uptake at the left 6th rib, resulting in a “banana-like appearance” and a ground glass appearance on the corresponding single-photon emission computed tomography (SPECT), in keeping with fibrous dysplasia. Given his asymptomatic state, the patient received reassurance and surveillance regarding his benign bone lesion.
Keywords
Banana-like appearance in bone scintigraphy
rib fibrous dysplasia
single-photon emission computed tomography
Discussion
Fibrous dysplasia is a spectrum of disease; it can also appear as sclerotic and cystic, such as a uniformly dense sclerotic pattern is seen in two-thirds of temporal bone involvement cases. The cystic type is characterized by ovoid lucency surrounded by dense bone cortex.[123] In plain radiographs, the differential diagnosis that has a similar appearance to fibrous dysplasia includes aneurysmal bone cyst, simple bone cyst, or giant cell tumor.[45] The presence of cortical disruption associated with soft tissue mass/lesion should raise the possibility of malignant transformation of the fibrous dysplasia. Bone scintigraphy usually exhibits a marked increase in activity of the bone involved in fibrous dysplasia in early perfusion imaging as well as delayed scans.[4]
Although the appearance of fibrous dysplasia in bone scintigraphy is nonspecific, there are some characteristics in bone scintigraphy that will help us to differentiate between this benign bone lesion and metastatic bone disease. In this case, bone scintigraphy and single photon emission computed tomography (SPECT) demostrate homegenous increased tracer uptake in left anterior giving rise to banana like appearance of rib [Figures 1 and 2].
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal his identity, but anonymity cannot be guaranteed.
Conflicts of interest
There are no conflicts of interest.
Nil.
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