Unusual Gallium Localization - B-Cell Lymphoma

Fig. 1  Post 72 hour whole body gallium imaging for a 74 year old patient, with B cell lymphoma

Gallium scans, in general, are fairly routine in helping clinicians to understand the extent of certain lymphomas in their patients.  For the most part PET imaging is the standard of care in many parts of the world, but with limited access to this type of imaging in certain provinces, we still rely on gallium (ole faithful).

What is interesting about the image above is the location of the gallium avid tumours.  I personally have never seen uptake in the actual arm itself.  The images above describes the uptake in the right infraclavicular lymph nodes, right axillary lymph nodes, soft tissues lateral to the mid shaft of the humerus and soft tissues posterior/lateral to the distal shaft of the humerus.  A SPECT/CT was performed, which included the arms and thorax.  The sagittal slice reconstruction below helps in clarifying the location of the tumours in the arm.

Fig. 3 Sagittal reconstruction of the right arm localizing the  gallium avid tumours.   The  video below is the 2-bed SPECT scan of the patient.

The patient initially presented with anemia.  Upper and lower gastrointestinal investigations did not reveal anything out of the ordinary, but the blood work for hemoglobin, mean corpuscular volume (MCV) and ferritin results were abnormal. The lumps and nodules in the right arm have been present for 8 years, and it was only recently that they began to grow in size, but were not painful.  The patient was diagnosed with diffuse B cell lymphoma and is currently undergoing treatment.