Case Author(s): Tate Allen, M.D. and Tom R. Miller, M.D., Ph.D. , 10/9/98 . Rating: #D2, #Q3

Diagnosis: Osteomyelitis

Brief history:

This is a 52 year-old diabetic with a foot ulcer.

Images:

Delayed Bone Scintigraphy

View main image(bs) in a separate image viewer

View second image(bs). Plantar Flow Images

View third image(bs). Plantar Immediate Static Image

View fourth image(xr). Right Foot Plain Film

Full history/Diagnosis is available below

Diagnosis: Osteomyelitis

Full history:

This is a 52 year-old diabetic man with a right plantar ulcer over the 3rd digit which has been present for three months. Recently, the patient has had a low grade fever and worsening foot pain.

Radiopharmaceutical:

21.3 mCi Tc-99m MDP i.v.

Findings:

There is increased blood flow to the right forefoot with increased blood pool activity. Delayed images show marked uptake at the right third distal metatarsal and proximal phalanx. These findings are consistant with osteomyelitis of these bones and possible third metatarsal-phalangeal joint infection. In addition, there is diffusely increased activity in the right foot soft tissue and bones. This is consistant with hyperemia and cellulitis. The plain films show no osseous abnormalities.

Discussion:

Bone scintigraphy is commonly abnormal before plain film findings are apparent.

Followup:

The patient was started on i.v. antibiotics.

ACR Codes and Keywords:

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

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Case number: bs096

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