Technetium-99m Medronate uptake in subcutaneous soft-tissue nodules in a patient with renal failure and renal adenocarcinoma

Subcutaneous heparin preparations are often used for prophylaxis of post-operative deep venous thrombosis. We report a case in which uptake of the bone scanning agent 99Tcm methylene diphosphonate (Medronate) into subcutaneous heparin injection sites misleadingly suggested metastases from a renal adenocarcinoma. A 45-year-old man with adult polycystic kidney disease reached end-stage renal failure. Thrice weekly hospital haemodialysis via radial arterio-venous fistula was the chosen method of treatment. During the following 7 months he suffered recurrent right loin pain with associated urinary tract infections and two episodes of bacteriologically confirmed septicaemia. Table I shows his pre-dialysis biochemical values during this time. Before including him in the UK Transplant Programme it was decided to remove the right kidney.