Case Author(s): Michael Quinn, M.D. and Barry A. Siegel, M.D. , 07/18/97 . Rating: #D2, #Q4

Diagnosis: Osteomyelitis of the right tibia

Brief history:

5-year-old boy with a 3-day history of limping.


Radionuclide angiogram (top row) Immediate (blood-pool) images (bottom row)

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View second image(bs). Delayed images

Full history/Diagnosis is available below

Diagnosis: Osteomyelitis of the right tibia

Full history:

5-year-old boy with a 3-day history of limp and painful right ankle. The patient is afebrile, and examination shows no local erythema or swelling. Laboratory studies show an elevated erytrocyte sedimentation rate


Tc-99m MDP


Increased activity on all phases in the distal right tibial metaphysis.


Children are more prone to acute hematogenous osteomyelitis than are adults. The site of infection usually involves areas of rapid growth, such as the metaphyses of long bones (distal femur and tibia, proximal femur and humerus). Flow dynamics also play a part in seeding of the physeal region by blood-borne pathogens. Radiographs are often normal early in the process and, therefore, bone scintigraphy is often employed to establish the diagnosis. In difficult cases, bone scintigraphy can be combined with imaging with another agent, such as Ga-67 or radiolabeled leukocytes to help establish the diagnosis. In osteomyelitis, there is typically a focal increase in activity in the affected bone on all phases of the study. This should be differentiated from cellulitis, where diffusely increased activity is expected in the soft tissues of the involved region on the early images, with only mildly increased activity in the underlying bone on the delayed images.

Differential Diagnosis List

Infection, fracture, tumor

ACR Codes and Keywords:

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

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Case number: bs079

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