Case Author(s): Brigid Gordon, MD and Henry Royal, MD , 08/04/96 . Rating: #D2, #Q4
Diagnosis: Reflex Sympathetic Dystrophy
Brief history:
56 year old female s/p right distal radius fracture two months ago, now with pain and burning in her right hand.
Images:
Anterior, palmar view of both hands
View main image(bs) in a separate image viewer
Full history/Diagnosis is available below
Diagnosis: Reflex Sympathetic Dystrophy
Full history:
This patient sustained a fracture of the distal right radius approximately
2 months prior to this bone scan. Since the fracture, the patient describes
persistent pain and burning in the right hand with associated swelling and
redness.
Radiopharmaceutical:
TC99m-MDP
Findings:
Three-phase bone scintigraphy demonstrated a classic pattern for reflex
sympathetic dystrophy syndrome. The dynamic perfusion phase of the
radionuclide angiogram and the immediate static images (not included)
demonstrated increased activity in the distal affected limb, particularly
in the periarticular region. On the 3 hour delayed view, the most
prominent activity is again identified in the periarticular regions of
the affected limb when compared to the normal limb. Also noted is increased
activity at the healing fracture site.
Discussion:
Adult reeflex sympathetic dystrophy syndrome has been described as having
three phases: 0-20 weeks with increased tracer activity (particularly in
the periarticular regions) on all three phases of the study; 20-60 weeks
with normal tracer activity in the first and second phases of the study
and increased tracer activity (particularly in the periarticular regions)
in the third phase; and, 60-100 weeks with normal or reduced tracer
activity in the first and second phases of the study and normal bone
activity in the third phase. These bone scintigraphy findings in addition
to physical findings and symptoms highly suggestive of reflex sympathetic
dystrophy syndrome.
References: Diagnostic Nuclear Medicine. 1996, 3rd edition.
ed., Sandler, et al.,
Major teaching point(s):
Post-traumatic bone and joint changes.
Differential Diagnosis List
Reflex sympathetic dystrophy vs. inflammatory arthropathy.
ACR Codes and Keywords:
References and General Discussion of Bone Scintigraphy (Anatomic field:Skeletal System, Category:Effect of Trauma)
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Case number: bs063
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