Diffuse Splenic Uptake on 99mTc MDP Bone Scintigraphy Secondary to Transfusion-Related Hemosiderosis

A 70-year-old woman with a past medical history of breast cancer is undergoing surveillance. She also had a history of repeated blood transfusions for refractory anemia caused by treated marrow metastatic disease. Laboratory tests showed elevated AST (50 U/L) and ALT (115 U/L). 99mTc MDP bone scintigraphy revealed intense diffuse splenic uptake. No splenic calcifications or infarcts were found on contrast-enhanced CT. MRI demonstrated signal dropout on in-phase sequences and marked T2 hypointensity of the spleen and liver, without focal splenic lesions, suggesting transfusion-related secondary hemosiderosis. Iron overload should be considered when diffuse splenic uptake is observed on bone scintigraphy.