The ability of Tc-99m radiocolloid bone marrow scanning to detect skeletal metastases is well known and indeed has been advocated as a useful adjunct to routine bone scanning in malignant disease. Cold defects on indium-111 leukocyte images have been reported occasionally due to solid tumors. A case of a 74-year-old man who had a fever of unknown origin and in whom Tc-99m hexamethylpropylene amineoxime (HMPAO) labeled leukocyte scintigraphy detected multiple metastatic lesions is reported; these lesions were subsequently determined to be prostatic in origin and confirmed by bone scanning. Tc-99m HMPAO leukocyte imaging yields high-resolution, low-background images of the bone marrow. Noninfectious causes of fever may be occasionally diagnosed through close attention to the bone marrow distribution.
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