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Cold osteomyelitis. Radionuclide bone scan findings
Abstract:
Absence of Tc-99m MDP accumulation in bone may be due to various causes, including infection, infarction, neoplasm, foreign bodies, or artefacts (1,2). In our patient, absence of radionuclide was noted in the proximal metaphyseal region of his left tibia, along with increased activity distally. These findings were attributed to a "cold" osteomyelitis caused by pus beneath the periosteum. Initial x-rays were interpreted as normal, while subsequent films demonstrated gross abnormalities. Few cases of cold osteomyelitis have been reported.
Insights
Cold osteomyelitis, a rare condition, presents as an absence of Technetium-99m MDP uptake in bone scans. This case highlights its potential to mimic other bone pathologies, challenging initial diagnoses.
Area of Science:
- Nuclear Medicine
- Orthopedic Surgery
- Radiology
Background:
- Technetium-99m MDP bone scintigraphy is a standard imaging modality for evaluating bone pathologies.
- Absence of radionuclide uptake ('cold' lesions) can indicate various conditions like infection, infarction, neoplasm, or foreign bodies.
- Cold osteomyelitis is an uncommon presentation of bone infection.
Observation:
- A patient presented with an absence of Tc-99m MDP accumulation in the proximal left tibia, with increased uptake distally.
- Initial radiography was interpreted as normal.
- Subsequent radiographic examinations revealed significant abnormalities.
Findings:
- The observed scintigraphic pattern was attributed to "cold" osteomyelitis, specifically subperiosteal pus.
- This presentation underscores the diagnostic challenges posed by atypical "cold" bone lesions.
- The rarity of reported "cold" osteomyelitis cases emphasizes the need for increased awareness.
Implications:
- This case highlights the importance of considering "cold" osteomyelitis in the differential diagnosis of bone lesions with absent Tc-99m MDP uptake.
- It emphasizes the potential for "cold" osteomyelitis to present with initially normal or subtly abnormal radiographic findings.
- Further investigation and awareness are crucial for accurate and timely diagnosis of this rare condition.