Key words

IJNM

Indian Journal of Nuclear Medicine

0972-3919

Society of Nuclear Medicine, India

ijnm-22-4-032

RESEARCH ARTICLE

Tramline Sign in Bone Scan in Ca Lung Patient: A Case Report

Mathur

Mohare

C P

Arya

Panday

R K

Deptt. of Nuclear Medicine and, Deptt. of Radiation Oncology, Jawaharlal Nehru Cancer Hospital & Research Centre, Idgah Hills, Bhopal.)

122007

224

Key wordsTramline SignBone ScanCa Lung

Case Report

A male patient of age 77yrs having H/O Bidi smoking for 60 yrs & H/O Alcoholism for 3040yrs. He left bidi smoking and alcoholism since 3–4 years. He complains weakness & loss of appetite Since 3–4 months, cough since 2–3 months. He feels dyspnoea on exertion for 1 week.

Reveal numerous singly scattered polygonal atypical keratinized squamous cells showing pyknotic nuclei and abundant well-defined eosinophilic cytoplasm. Occasional clusters of epithelial cells seen. These cells are admixed with acute inflammatory cells on a background of haemorrhage which reveals positive for malignant cells well differentiated keratinizing squamous cell carcinoma (Bronchiogenic Carcinoma) Echo Doppler Report reveals hypertensive heart disease with normal LV function.

Patient was referred for radionuclide bone scan. Skeletal scintigraphy was performed with 20 mCi 99mTc Methylene Diphosponate. Whole body static imaging was done in anterior and posterior projections 3hrs after dose administration. Scan reveals Hypertrophic pulmonary osteoarthropathy. Characteristic pericortical uptake. The cortical “strips” of activity (“tramline sign”) are evident as an irregular pattern in the long bones of the lower limbs, but are virtually absentin those of the upper limbs.

Discussion

In patients with cancer of the lung, a frequent incidental observation will be the changes associated with hypertrophic pulmonary osteoarthropathy. In 48 cases reviewed by Ali et al¹ the extremities were invariably involved, although with asymmetry in 17% with the exception of the humerus, the proximal and distal portions of each long bone were involved with equal frequency.

Involvement is also seen in the skull, scapulae, patellae & clavicles. The characteristics alteration in the long bones is intense pericortical uptake, the “tramline sign”. Changes in the hands may be obvious in the absence of clinical evidence of clubbing.

After treatment of the associated disease, there is usually rapid regression of the scintigraphic changes.

Normalization of the scan abnormalities has been reported with in 1 month of successful therapy.

Tramline Sign in Bone Scan in Ca Lung Patient: A Case Report

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