Hypofixation on bone scintigraphy in reflex sympathetic dystrophy syndrome

Area of Science:

• Medical Imaging
• Neurology
• Pain Management

Background:

• Reflex sympathetic dystrophy (RSD), also known as complex regional pain syndrome (CRPS), is a chronic pain condition.
• Typical imaging findings in adults include hyperperfusion and hyperfixation.

Observation:

• An adult patient presented with symptoms consistent with RSD.
• Unusual findings were noted on three-phase bone scintigraphy of the affected lower limb.

Findings:

• The bone scan revealed decreased blood flow and blood pool.
• Delayed imaging showed hypofixation on the steady-state bone scan, contrary to typical adult presentations.
• Despite multiple therapeutic interventions, the patient developed severe dystrophy.

Implications:

• This case challenges the conventional understanding of bone scintigraphy patterns in adult RSD.
• It underscores the need for considering atypical presentations in diagnosing and managing complex pain syndromes.
• Further research may be needed to elucidate the pathophysiology behind these divergent imaging findings and to develop more effective treatments.