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Ectopic hematopoietic bone marrow in the appendicular skeleton after trauma

A Kaim1, P Ochsner, T Maurer

  • 1Institute of Nuclear Medicine, University Hospital Basel, Switzerland.

Journal of Nuclear Medicine : Official Publication, Society of Nuclear Medicine
|November 26, 1998
PubMed
Summary

Ectopic bone marrow can mimic infection on imaging, leading to misdiagnosis. This study highlights how hematopoietic marrow can cause false positives in osteomyelitis diagnosis.

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Area of Science:

  • Nuclear Medicine
  • Orthopedic Surgery
  • Histopathology

Background:

  • Chronic osteomyelitis diagnosis often involves bone scanning and immunoscintigraphy (IS).
  • Distinguishing infection from other causes of radiotracer uptake is crucial for accurate diagnosis and treatment.

Observation:

  • Two patients with suspected lower extremity osteomyelitis showed positive results on both bone scanning and IS.
  • Surgical intervention was performed based on positive imaging findings.

Findings:

  • Histopathology revealed ectopic hematopoietic bone marrow, not infection, in both patients.
  • This bone marrow exhibited physiologic uptake on IS, mimicking granulocyte accumulation.
  • One patient had active marrow at a previous fracture site; the other had marrow within cortical bone after surgery.

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Implications:

  • Ectopic hematopoietic marrow can occur in the appendicular skeleton following trauma and surgery.
  • Physiologic uptake by this marrow can lead to false-positive diagnoses of osteomyelitis.
  • This finding necessitates careful interpretation of IS in patients with a history of skeletal trauma or surgery.