대한흉부영상의학회 Korean Society of Thoracic Radiology

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Weekly Chest CasesArchive of Old Cases

Case No : 1382 Date 2024-04-17

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  • Courtesy of Minseon Kim / Bundang Seoul National University Hospital
  • Age/Sex 43 / F
  • Chief ComplaintAbnormal findings on chest CT during routine breast cancer follow-up
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5

Diagnosis With Brief Discussion

Diagnosis
Vanishing bone metastasis
Radiologic Findings
Fig 1-2. Axial and sagittal thoracic contrast-enhanced CT images show multiple high-density bone lesions in cervical and thoracic vertebral bodies.
Fig 3. These findings were not present on a previous CT scan performed 5 months earlier.
Fig 4. Three weeks later, a spine MRI with contrast enhancement was performed. Contrast-enhanced T1-weighted images (T1WI) reveal fuzzy enhancement and prominent collateral vessels along the vertebral bodies.
Fig 5. PET CT performed on the same day as the spine MRI showed no abnormal FDG uptakes observed elsewhere in the vertebral bodies.
Brief Review
Vanishing bone metastasis (VBM) is a phenomenon observed in contrast-enhanced CT scans, often misinterpreted as bone metastasis. This condition predominantly occurs in patients with thoracic vein obstruction, such as the superior vena cava, leading to pseudopathological enhancement in bones. VBM results from blood congestion in the paravertebral venous plexus, causing contrast accumulation that mimics sclerotic lesions. Awareness of VBM is crucial in radiological imaging, especially for patients with superior vena cava obstruction, to avoid misdiagnosis and unnecessary treatments for metastatic disease.
References
1. Fukamizu EMN, Seabra A, Otto DY, Sawamura MVY, Bordalo-Rodrigues M, Helito PVP. Vanishing bone metastasis: pictorial essay. Radiol Bras. 2021;54(5):336-340. doi:10.1590/0100-3984.2020.0124
2. Thomas N, Oliver TB, Sudarshan T. Vanishing bone metastases--a pitfall in the interpretation of contrast enhanced CT in patients with superior vena cava obstruction. Br J Radiol. 2011;84(1005):e176-e178. doi:10.1259/bjr/50676625
Keywords

No. of Applicants : 67

▶ Correct Answer : 35/67,  52.2%
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - , Japan SUZUNE TSUKAMOTO
  • - medical scanning , Japan HIROAKI ARAKAWA
  • - The University of Tokyo Hospital , Japan JUN KANZAWA
  • - Shiga University of Medical Science , Japan AKITOSHI INOUE
  • - McGill University Health Center , Canada ALEXANDRE SEMIONOV
  • - Kyoto City Hospital , Japan YUSUKE UTSUNOMIYA
  • - , Korea (South) DONG-HO BANG
  • - Healthy Longevity Medical Center , Japan SHIN-ICHI CHO
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - Other , Korea (South) SEONGSU KANG
  • - Secomedic Hospital , Japan FUMINORI MIYOSHI
  • - Uniyersity of Yamanashi , Japan TAKAAKI HASHIMOTO
  • - Osaka University , Japan AKINORI HATA
  • - University of Yamanashi , Japan HIROYUKI MORISAKA
  • - Other , Korea (South) HYEJOO PARK
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - , Japan YOSHIKI ISHII
  • - Gifu University Hospital , Japan Yo Kaneko
  • - Nankai medical center , Japan NORITAKA KAMEI
  • - Kyoto University Hospital , Japan YASUHISA KURATA
  • - Ome Medical Center , Japan MIKIYA FUJII
  • - Jichi Medical University, School of Medicine , Japan MITSURU MATSUKI
  • - GHICL , France MANUEL TOLEDANO
  • - Korea University Anam Hospital , Korea (South) KYU-CHONG LEE
  • - Paras hospital, Panchkula , India SHALEEN RANA
  • - Hyogo Prefectural Kobe Children , Japan SHUHEI NORIMOTO
  • - Yonsei University,Severance Hospital , Korea (South) SEO BUM CHO
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - Matsunami General Hospital , Japan TARO TAKEDA
  • - Toyota Kosei Hospital , Japan YUKI HAYASHI
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - University of Yamanashi , Japan KOJIRO ONOHARA
  • - , Korea (South) JIN WOO YOON
  • - Jiangsu province hospital , China WANGJIAN ZHA
▶ Correct Answer as Differential Diagnosis : 2/67,  3.0%
  • - Osaka Metropolitan University Hospital , Japan SHU MATSUSHITA
  • - Kyoto University , Japan SHO KOYASU
▶ Semi-Correct Answer : 2/67,  3.0%
  • - university of montreal , Canada Andrei Bogdan Gorgos I
  • - , Japan SHUNJIRO NOGUCHI
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