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Cold osteomyelitis. Radionuclide bone scan findings.

B J Barron, R D Dhekne

    Clinical Nuclear Medicine
    |July 1, 1984
    PubMed
    Summary
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    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.

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  • 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.