Unexpected Pyelonephritis Incidentally Revealed on 99mTc MDP Bone Scintigraphy

Area of Science:

• Pediatric Nephrology
• Nuclear Medicine
• Diagnostic Imaging

Background:

• Intermittent fever in children can indicate various underlying conditions.
• Occult osteomyelitis is a diagnostic challenge, often requiring advanced imaging.
• Technetium-99m methylene diphosphonate (Tc-99m MDP) scintigraphy is used for bone lesion evaluation.

Observation:

• A 5-year-old girl presented with a 4-month history of intermittent fever.
• Tc-99m MDP bone scintigraphy was performed to rule out osteomyelitis.
• The bone scan showed no evidence of bone lesions.

Findings:

• Abnormal Tc-99m MDP uptake was observed in the upper poles of both kidneys.
• These findings were subsequently confirmed as pyelonephritis.
• The diagnostic utility of bone scintigraphy extended beyond its primary indication.

Implications:

• Tc-99m MDP scintigraphy can reveal unexpected findings indicative of renal pathology.
• This case highlights the importance of considering differential diagnoses when interpreting imaging studies.
• Early diagnosis and management of pyelonephritis are crucial in pediatric patients to prevent complications.