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Technetium-99m-Methylene Diphosphonate (MDP) Uptake in a Sympathetic Effusion: An Index of Malignancy and a Review of the Literature

Department of Radiology and Laboratory Services, Medical College of Virginia, Richmond, Virginia
Nuclear Medicine Service, Department of Veteran's Affairs Medical Center, Richmond, Virginia

Correspondence: For reprints contact: Jesse Balsesro, MD, Chief, Nuclear Medicine Service (115), Department of Veteran's Affairs Medical Center, Richmond, VA 23249

ABSTRACT

We report a patient with a sympathetic pleural effusion secondary to T-cell lymphoma that accumulated the bone imaging agent, Technetium-99m-methylene diphosphonate (^99mTc-MDP). This case is significant in that malignant cells were not present on three cytologic examinations of the pleural fluid or multiple pleural biopsies. We also present a review of the published literature on pleural effusions that accumulate bone tracers. We conclude that pleural effusions that accumulate ^99mTc-MDP should be considered malignant or secondary to a malignancy and further work-up is essential even if the cytologic exam of the pleural fluid is unremarkable.