Bone marrow uptake complicating radionuclide venography in a patient with sickle cell anemia

A 49-year-old black woman with hemoglobin SS sickle cell disease presented with right calf pain and swelling. She had a history of deep venous thrombophlebitis of the left calf. Because of the risks of iodinated contrast in patients with sickle cell disease, a radionuclide venogram was performed with Tc-99m labeled red blood cells. This revealed intense uptake in the bone marrow, which significantly interfered with visualization of the deep venous structures in the patient's lower legs. Assessment of venous patency in this area could not be made. Hyperemia of the bone marrow secondary to the patient's sickle cell disease is felt to be responsible for the unusual pattern of uptake. This case demonstrates a potential limitation of labeled red blood cell radionuclide venography in patients with hyperemic bone marrow.