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[An unusual bone scintigram in osteomyelitis. A case report]
G Lehner1, H F Kessel, D Hoffmann
1Nuklearmedizinische Klinik und Poliklinik, Universität Würzburg.
Der Radiologe
|September 1, 1992
Summary
In acute osteomyelitis, bone scintigraphy may show decreased technetium-99m methylene diphosphonate uptake despite hyperemia. This finding in pediatric femur osteomyelitis suggests reduced blood flow due to vascular issues.
Area of Science:
- Pediatric imaging
- Nuclear medicine
- Orthopedic infections
Background:
- Acute osteomyelitis is a bone infection common in children.
- Bone scintigraphy using technetium-99m methylene diphosphonate (99mTc-MDP) is a standard diagnostic tool.
- Hyperemia, or increased blood flow, is typically expected in infected bone areas.
Observation:
- A 7-year-old boy presented with acute osteomyelitis of the femur.
- Bone scintigraphy revealed hyperemia during the blood-pool phase.
- Paradoxically, there was decreased 99mTc-MDP concentration in the affected femur.
Findings:
- The decreased nuclide concentration, despite hyperemia, is an unusual finding in pediatric osteomyelitis.
- This suggests that factors beyond simple inflammation are affecting radiotracer uptake.
- Reduced blood flow secondary to thrombotic occlusion or compression of bone-supplying vessels is a potential explanation.
Implications:
- This case highlights the complexity of interpreting bone scintigraphy in pediatric osteomyelitis.
- It suggests considering vascular compromise as a cause for decreased radiotracer uptake.
- Further investigation into vascular supply may be warranted in similar presentations to ensure comprehensive diagnosis and treatment.