Visualization in the Ipsilateral Lymph Nodes Secondary to Extravasation of a Bone-Imaging Agent in the Left Hand: A Case Report

DISCUSSION

Incidental axillary or elbow lymph node visualization after subcutaneous infiltration of the bone-imaging agent into the antecubital or wrist region has been reported (1–5). Visualization of lymph nodes in the elbow region resulting from the extravasation of bone-imaging agent in the wrist area has also been described (6). Our patient’s injection site for the bone-imaging agent was located on the distal dorsal area of the left hand, near the dorsal portion of the little and ring fingers. As per routine imaging, the bone scintigraphy was acquired 3 h after radiopharmaceutical injection. The extravasation appeared to be a substantially large amount of the total injected dose. This was shown by the intense uptake in the large area in the dorsal aspect of the left hand even 3 h after administration. Also note that the time required to acquire the total-body image (Fig. 1) and spot images (Fig. 2) was unusually prolonged. Over 3 h, gradual transportation of bone-imaging agent in the cephalic direction occurred, resulting in an incremental decrease in radioactive uptake in the lymph nodes in the distal to proximal direction.