Unintentional intra-arterial administration of 99mTc-HDP during bone scintigraphy in a 64-year-old patient – case report
Authors:
M. Bejtic 1,2; V. Kamírová 1; O. Lang 1,3; M. Lang 1
Authors‘ workplace:
Prague Medical Care Department, s. r. o., Praha
1; Fakulta biomedicínského inženýrství, České vysoké učení technické v Praze
2; 3. Kardiologická klinika, 3. LF UK Praha, ČR
3
Published in:
NuklMed 2025;14:39-43
Category:
Casuistry
Overview
Bone scintigraphy using the radiopharmaceutical technetium-99m hydroxymethylene diphosphonate (99mTc-HDP) is a key diagnostic method in oncology and metabolic bone diseases. Proper intravenous administration of the radiopharmaceutical ensures homogeneous distribution within the bones and reliable imaging results. In this case report of a 64-year-old female patient, an unintentional intra-arterial administration of 99mTc-HDP led to a localized excessive accumulation of activity in the distribution area of the radial artery – known as the “hot glove” phenomenon¹. This article provides a detailed analysis of the mechanism and pathophysiology of this phenomenon, its diagnosis and differential diagnosis including possible imaging artifacts, clinical consequences and complications, preventive measures to minimize risk, a comparison with relevant literature, and options for managing the situation. Emphasis is placed on differentiating this technical artifact from genuine pathology to avoid unnecessary invasive examinations or therapeutic interventions.
Keywords:
bone scintigraphy – nuclear medicine – 99mTc-HDP – intra-arterial administration – “hot glove” phenomenon – imaging artifacts
Sources
- Shih WJ, Wienrzbinski B, Ryo UY. Abnormally increased uptake in the palm and the thumb as the result of a bone imaging agent injection into the radial artery. Clin Nucl Med. 2000;25 : 539–540
- Nguyen BD. Technetium-99m MDP extravasation with cutaneous pattern of ulnar innervation. Clin Nucl Med. 2004;29 : 640–641
- Bozkurt MF, Uğur O. Intra-arterial Tc-99m MDP injection mimicking reflex sympathetic dystrophy. Clin Nucl Med. 2001;26 : 154–156
- Zhu Z, Zhu X, Lan X, et al. Inadvertent intraarterial injection of 18F-FDG: a case report and literature review of hot forearm and hot hand signs. J Nucl Med Technol. 2011;39 : 249–251
- Van der Pol J, Vöö S, Bucerius J, Mottaghy FM. Consequences of radiopharmaceutical extravasation and therapeutic interventions: a systematic review. Eur J Nucl Med Mol Imaging. 2017;44 : 1234–1243
- Ceylan Günay E, Erdoğan A. Asymmetrically increased uptake in upper extremities on 99mTc-MDP bone scintigraphy caused by intra-arterial injection: different uptake patterns in three cases. Rev Esp Med Nucl Imagen Mol. 2011;30 : 372–375
- Gholami A, Jafaripour I. Specific pattern of bone scan as a result of unintentional-intraarterial injection into the ulnar artery. Caspian J Intern Med. 2022;13 : 439–441
- Harris S, Crowley JR, Warden N. Radiopharmaceutical administration practices—Are they best practice? Front Nucl Med. 2023 Oct 13;3 : 1244660. doi: 10.3389/fnume.2023.1244660
- Zuckier LS, Martineau P. Altered biodistribution of radiopharmaceuticals used in bone scintigraphy. Semin Nucl Med. 2015;45 : 81–96
- Gerard PS, Peterson L, Buse D et al. Compartment syndrome caused by CT contrast infiltration seen on a 99mTc-MDP bone scan. Clin Nucl Med. 2008;33 : 36–37
- Sohn MH, Jeong HJ, Lim ST, et al. Abnormally increased uptake on bone scintigraphy in the long bone proximal to a tourniquet: an injection artifact. Clin Nucl Med. 2010;35 : 349–350
- Kumar K. Abnormally increased uptake of 18F-FDG in the forearm and hand following intra-arterial injection – hot forearm and hot hand signs. Br J Radiol. 2009;82 : 995–999
Labels
Nuclear medicine Radiodiagnostics RadiotherapyArticle was published in
Nuclear Medicine
2025 Issue 3
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