Joint Program in Nuclear Medicine

Findings, case of Swollen, Painful Fingers

Imaging Findings

• Plain film radiographs of left hand and right hand demonstrated diffuse soft tissue swelling of the digits bilaterally but no bony abnormalities.
• Immediately following the IV administration of 20 mCi of Tc-99m MDP vascular phase images of the hands were obtained that showed no significant radiotracer activity in the mid and distal phalanges 2 through 5 bilaterally. Slightly increased perfusion was noted in the thumbs.
• Tissue phase images in the palmar projection obtained at 20 minutes again demonstrated no significant radiotracer activity in the mid and distal 2nd through 5th digits. Moderately increased activity was again noted in the thumbs, most prominently in the proximal left thumb, and also in the region of the left fifth metacarpal. The images were repeated with cobalt markers to identify the location of the tips of the 3rd digits.
• Delayed-phase images in the palmar projection were obtained at 4 hours with cobalt markers at the tips of digits 2 through 4 bilaterally. On these images radiotracer activity is seen in soft tissue and bony structures of the distal phalanges of both hands with the exception of the left fifth distal phalanx. Focally increased uptake is seen in the metacarpophalangeal joints, the interphalangeal joints of the thumbs, and in the metacarpophalangeal joints of the 2nd through 4th digits bilaterally. Slightly increased uptake is also noted in the left first carpometacarpal joint and in the radiocarpal joints bilaterally.

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