Case Author(s): Tate Allen, M.D. and Tom R. Miller, M.D., Ph.D. , 07/17/98 . Rating: #D2, #Q3

Diagnosis: Osteomyelitis of the calcaneous

Brief history:

55 year-old man with left heal pain.


Delayed bone scintigraphy, anterior and left lateral views of the feet

View main image(bs) in a separate image viewer

View second image(bs). Anterior bone scintigraphy, flow images

View third image(xr). Lateral X-ray of the left foot

View fourth image(iw). Tweny-four hour delayed indium-111 labeled WBC's, anterior and lateral views of the feet

Full history/Diagnosis is available below

Diagnosis: Osteomyelitis of the calcaneous

Full history:

This is a 55 year-old man with diabetes. He has undergone renal transplantation and now reports twisting his ankle two weeks ago with persistant pain and swelling in this area. The patient also reports recent low-grade fevers.


Tc-99m MDP i.v.


There is increased blood flow and delaved uptake on bone scintigraphy in the the left calcaneous. The plain film demonstrates a linear lucency and a metallic foreign body in this area. In addition, the delayed bone scintigraphy demonstrates increased activity at the second and first metatarsal heads. The plain films show possible diabetic osteolysis in these areas as well as post-surgical changes at the first metatarsal head. An In-111 labeled autologous leukocytes examination of the feet and ankles was performed. This shows increased uptake in the left calcaneus corresponding to the abnormalities on bone scintigraphy and radiographs.


On three phase bone scintigraphy, osteomyelitis will have increased uptake on all phases. Though sensitivity for osteomyelitis (above 95%) is excellent, it is usually much less specific. In-111-labeled WBC's can be used for further work-up of osteomyelitis. This exam has a reported specificity of 85% for osteomyelitis.

Reference: Thrall JH,Ziessman HA:Nuclear Medicine,The Requisites.St.Louis, Mosby,1995,p.167.


The patient was taken to the operating room for surgical debredment.

ACR Codes and Keywords:

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

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Case number: bs093

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