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Background
A nuclear medicine bone scan is often used to evaluate osseous pathologies primarily for metastasis, trauma, prosthesis loosening, and osteomyelitis. Recognizing incidental extra-osseous uptake patterns can provide crucial diagnostic information.

Educational Goals / Teaching Points
The goals are to provide a system-based, multimodality pictorial review and an approach to extra-osseous uptake patterns on a bone scan, knowledge of which allows for a confident diagnosis or may help narrow down the differential.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
We present a multimodality pictorial review of extra-osseous uptake patterns organized by body systems including CNS (meningiomas, cerebral infarcts), breast (breast cancer, mastitis, and lactation), cardiac (amyloidosis), endocrine (hyperparathyroidism, microcalcification of the thyroid cartilage), hepatobiliary and gastrointestinal (hepatic metastasis, free pertechnetate, visceral calciphylaxis, malignant ascites, omental caking, enterovesical fistula, splenic infarcts), genitourinary (obstruction, drug toxicity, hydronephrosis, horseshoe kidney, duplicated ureters with ureterocele, neuroblastoma, uterine fibroid, ovarian malignancy, bladder diverticula & hernia, prostatomegaly), muscular/soft tissue (myositis ossificans, bone flap viability, extremity hemangiomas, reflex sympathetic dystrophy, cellulitis, rhabdomyolysis, hot glove sign, hypertrophic pulmonary osteoarthropathy, dermatomyositis, juxta-articular tumoral calcinosis; radiotracer extravasation and node visualization; chest port injection site mimicking rib metastasis, Healing soft-tissue wounds), and respiratory (lung cancer, malignant pleural effusion, osteosarcoma metastasis, metastatic lung calcification).

Conclusion
This multimodality pictorial review highlights various patterns of extra-osseous uptake patterns on bone scans and raises awareness and strengthens the judgment of the reading physician for extra-osseous uptake.