Bone scans in sternal osteomyelitis complicating hemodialysis blood access

Sternal osteomyelitis complicating infection of vascular access for hemodialysis is exceedingly rare and presents serious diagnostic and therapeutic difficulties. Two hemodialysis patients with sternal osteomyelitis following vascular access infection are reported. Factors favoring sternal location of the infection included previous chest trauma in the first patient and difficult insertion of a dialysis subclavian catheter in the second patient. Indium oxine, gallium, and three-way bone scans were instrumental in establishing diagnosis and in documenting cure by prolonged antibiotic courses. Sternal scans should be performed in dialysis patients with vascular access infections and signs of sternal disease.