[1]陈婷,刘超,邓智勇.多发性骨髓瘤双肺弥漫性摄取99Tcm-MDP一例[J].国际放射医学核医学杂志,2018,(1):87-89,94.[doi:10.3760/cma.j.issn.1673-4114.2018.01.017]
　Chen Ting,Liu Chao,Deng Zhiyong.Diffuse bilateral pulmonary uptake 99Tcm-MDP in a patient with multiple myeloma: a case report[J].International Journal of Radiation Medicine and Nuclear Medicine,2018,(1):87-89,94.[doi:10.3760/cma.j.issn.1673-4114.2018.01.017]
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《国际放射医学核医学杂志》[ISSN:1673-4114/CN:12-1381/R]

卷:
期数:
2018年第1期
页码:
87-89,94
栏目:
病例报告
出版日期:
2018-03-20

文章信息/Info

Title:
Diffuse bilateral pulmonary uptake 99Tcm-MDP in a patient with multiple myeloma: a case report
作者:
陈婷;  刘超;  邓智勇
650118 昆明, 云南省肿瘤医院, 昆明医科大学第三附属医院核医学科
Author(s):
Chen Ting;  Liu Chao;  Deng Zhiyong
Department of Nuclear Medicine, Tumor Hospital of Yunnan Province, The Third Affiliated Hospital of Kunming Medical College, Kunming 650118, China
DOI:
10.3760/cma.j.issn.1673-4114.2018.01.017
摘要:
笔者报道了一例腰骶部及双下肢疼痛、活动受限1年入院的病例。从临床症状、实验室检查、影像学检查、骨髓细胞形态学检查及术后病理检查的结果诊断为多发性骨髓瘤。临床表现为急性肾功能衰竭、高钙血症、骨髓造血功能障碍及肺部感染。行全身骨显像发现患者双肺弥漫性摄取99Tcm-MDP。相关文献显示，多发性骨髓瘤可引起肾功能不全，并通过诱发继发性甲状旁腺功能亢进导致高钙血症，Ca2+沿浓度梯度被动转运至肺泡及支气管上皮细胞，与线粒体结合形成转移性微钙化灶，可摄取99Tcm-MDP并在SPECT中显影。结合患者病史、检查结果及相关文献，综合分析考虑双肺广泛转移性微钙沉积是引起99Tcm-MDP弥漫性显影的主要原因。由于双肺转移性钙化灶非常微小，通过普通的影像学检查手段很难发现，而且此类患者常伴随重度通气障碍，预后极差，因此99Tcm-MDP显像不失为一种诊断及疗效评估的手段，提示临床医师尽早采取积极的对症治疗，改善患者预后，降低病死率。
Abstract:
The author reports a patient who was admitted due to ‘pain in the lumbosacral region and bilateral lower limbs with limited activity for 1 year’. Based on clinical symptoms, laboratory tests, imaging examinations, bone marrow cell morphological examinations, and postoperative pathology, the patient was diagnosed with multiple myeloma, acute renal failure, hypercalcemia, hematopoietic dysfunction of bone marrow, and pulmonary infection. Moreover, SPECT revealed diffuse uptake of 99Tcm-MDP in bilateral pulmonary. Relevant literature suggests that multiple myeloma may cause renal insufficiency and induce secondary hyperparathyroidism, thereby leading to hypercalcemia. In the resulting hypercalcemia, Ca2+ is passively transported along the concentration gradient to the pulmonary alveoli and bronchial epithelial cells, where Ca2+ binds to the mitochondria and forms metastatic microcalcifications that take up 99Tcm-MDP and are opacified in SPECT. Combining medical history, examination results, and relevant literature, we suspected that extensive metastatic microcalcium deposition in the bilateral pulmonary mainly causes the diffuse development of 99Tcm-MDP. The metastatic calcification in bilateral pulmonary is low; therefore, it is difficult to detect using common imaging methods. Moreover, these patients always have severe ventilatory disorders, which have extremely poor prognosis. Therefore, 99Tcm-MDP imaging may be used to evaluate the diagnosis and efficacy, thus suggesting that clinicians should perform active symptomatic treatment as early as possible to improve prognosis and reduce mortality.

参考文献/References:

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备注/Memo

备注/Memo:
收稿日期:2017-11-25。
通讯作者:邓智勇,Email:13888158986@126.com
更新日期/Last Update: 2018-03-20