Acute myelofibrosis mimicking multiple bone metastases on Tc-99m MDP bone imaging

Purpose: Tc-99m bone scintigraphy is widely used for evaluation of osseous spread of malignant tumors. Patient: A 60-year-old man had multiple areas of increased uptake on a bone scan in a pattern considered characteristic for extensive metastatic disease. However, a primary neoplasm could not be identified. Finally, acute myelofibrosis-a rare, fatal myeloproliferative syndrome-was diagnosed. Conclusion: To avoid delays and extensive diagnostic procedures, acute myelofibrosis should be considered in the differential diagnosis of bone scans showing multiple hot spots. In such cases, a diagnosis can be made on an a tissue sample.