%0 Journal Article
%T Hypertrophic osteoarthropathy as the cause of a super scan of the bone in a patient with prostate cancer: a case report
%A Boris L Kanen
%A Ruud JLF Loffeld
%J Journal of Medical Case Reports
%D 2008
%I BioMed Central
%R 10.1186/1752-1947-2-104
%X A patient with a history of prostate cancer presented with pleural fluid, peripheral edema and bone pain. A super scan of the bone was found which suggested diffuse skeletal metastasis of the prostate cancer but the patient also had a prostate specific antigen level which was not compatible with this diagnosis. Further investigations revealed the paraneoplastic phenomenon of hypertrophic osteoarthropathy, related to an incurable carcinoma of the lung, to be the cause of the super scan.A super scan is characterized by a high bone to soft tissue ratio on skeletal scintigraphy, with a uniform symmetrical increase in bone uptake and diminished to absent renal visualization ('absent kidney sign'). It can be seen in a variety of diseases in which there is a diffusely increased bone turnover. Diffuse skeletal metastasis of a well-differentiated prostate carcinoma is unlikely to be the cause of a super scan when the prostate specific antigen level is not elevated. This is the first report of a super scan due to pulmonary hypertrophic osteoarthropathy which can be seen in lung carcinoma and other pulmonary diseases.Prostate cancer has a high tendency of metastasizing to the skeleton. In fact, many cases of this cancer are diagnosed because of the detection of bone metastasis from a primary tumor of unknown origin at the time of presentation. The majority of patients with metastatic prostate cancer will have multiple skeletal lesions. However, diffuse metastases are also described. These patients have a so-called super scan of the bone. Presence of a super scan is not pathognomic for diffuse bone metastasis. The differential diagnosis is wider as is described in this case report.A 81-year-old man with an adenocarcinoma of the prostate diagnosed one year earlier presented with a five month history of gradually progressive complaints of dyspnea. At the time of diagnosis of the prostate cancer, there had been no signs of metastases and since it was an asymptomatic grade 2 prosta
%U http://www.jmedicalcasereports.com/content/2/1/104