Original ArticleParadoxic Technetium-99 Methylene Diphosphonate Localization in Malignant MesotheliomaReidman, Daniel CPT, MC*; Balingit, Antonio LTC, MC† Author Information From the Departments of *Radiology and †Nuclear Medicine Service, Department of the Army, Madigan Army Medical Center, Tacoma, WA 98431. Received for publication October 15, 2004; revision accepted October 15, 2005. The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of the Army or Department of Defense. Reprints: Daniel Reidman, CPT, MC, Madigan Army Medical Center, MCHJ-R (Radiology), Tacoma, WA 98431. E-mail: [email protected] Clinical Nuclear Medicine: February 2006 - Volume 31 - Issue 2 - p 71-73 doi: 10.1097/01.rlu.0000195917.56036.cd Buy Metrics Abstract The literature is replete with cases of Tc-99m bone imaging agent uptake in pleural effusions. Far rarer is the report of photopenia in a pleural effusion. In this case of malignant mesothelioma, we describe a unique case of unilateral hemithoracic photopenia from a pleural effusion with concomitant uptake in the contralateral lung resulting from calcified pleural plaques. Although initially perplexing clinically, this case can be readily explained with an understanding of basic physiological principles. © 2006 Lippincott Williams & Wilkins, Inc.