Case Author(s): Mike Roarke, M.D, and Henry Royal, M.D. , 1/26/96 . Rating: #D2, #Q3

Diagnosis: Septic hip and surrounding myositis.

Brief history:

72-year old man with a history of C3-5 laminectomy and pseudomeningocele, now presents with history of fever and mental status changes.


Whole body bone scintigraphy images.

View main image(bs) in a separate image viewer

View second image(ga). Anterior image of the pelvis at 72 hours post injection.

View third image(ct). Axial CT images.

Full history/Diagnosis is available below

Diagnosis: Septic hip and surrounding myositis.

Full history:

72-year old male nursing home patient with a history of cervical laminectomy in the past requiring removal of hardware and debridement four months ago. Now presents with new mental status changes and fever. Whole body bone scintigraphy was requested to exclude recurrent osteomyelitis in the cervical spine.


Ga-67 citrate


Whole body delayed bone scintigraphy was performed. There is decreased activity in the cervical spine on the posterior view, corresponding to the prior laminectomy. No evidence of osteomyelitis is seen in this area. However, there is an area of decreased activity in the region of the right femoral neck and head with correspondingly increased activity in the acetabulum. Gallium scintigraphy obtained 72 hours post injection reveals increased activity in the soft tissues about the right hip joint. Computed tomography confirms enlarged edematous right hip musculature with only a small fluid collection in the region of the gluteus maximus muscle. Other than joint space narrowing, the right femoral head is symmetric in appearance with the left.


Gallium scintigraphy is often used to improve the specificity for the detection of osteomyelitis when focal areas of increased activity are seen on bone scintigraphy. In this case, gallium scintigraphy was useful in demonstrating that the majority of abnormal tracer accumulation occurred within the soft tissues surrounding the right hip. These findings were concordant with the finding of no significant abnormal soft tissue fluid collections in the surrounding musculature on computed tomography examination. While decreased Tc-99m MDP accumulation in the femoral head and neck can be seen in children with hip joint effusions, it is unusual for septic arthritis to produce decreased activity in the femoral head in an adult.


Aspiration of the right hip revealed staph aureus. The patient was not considered a surgical candidate and therefore was treated conservatively with intravenous antibiotics for six weeks. Follow-up plain radiographs of the right hip were not obtained as of this writing to determine whether or not avascular necrosis of the femoral head had occurred.

ACR Codes and Keywords:

References and General Discussion of Bone Scintigraphy (Anatomic field:Skeletal System, Category:Inflammation,Infection)

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Case number: bs051

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