A 49-year-old man with multiple myeloma underwent whole-body bone scanning for evaluation of bone pain. Blood tests indicated elevated serum concentrations of calcium, 17.3 mg/dL; phosphate, 5.2 mg/dL; and creatinine, 5.5 mg/dL. The bone scan revealed unusual diffuse pulmonary and stomach uptake, and also multiple hot spots in the ribs, probably resulting from pathologic fractures, and increased uptake in the bones of the extremities, most likely caused by metabolic bone disease. Diffuse lung uptake can be seen on a bone scan when there is a combination of hypercalcemia and renal failure, such as may be seen in neoplasms. Inflammation and systemic amyloidosis can be associated with this soft-tissue accumulation as well.
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