Case Author(s): Sarah Reimer, MD and Henry Royal, MD , . Rating: #D2, #Q3
Diagnosis: Femoral neck fracture
Brief history:
Demented patient with complaints of right leg pain and history of prostate cancer.
Images:
Anterior and posterior images
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View second image(xr).
AP view of the right hip
Full history/Diagnosis is available below
Diagnosis: Femoral neck fracture
Full history:
This 88-year-old demented man with a history of prostate cancer had been complaining of right leg pain. The bone scan was obtained to evaluate for possible osseous metastases.
Radiopharmaceutical:
Tc-99m MDP i.v.
Findings:
The bone scan demonstrates increased activity in the right
intertrochanteric region and absence of activity in the right
femoral head. Plain films were obtained for further evaluation
of this finding. These demonstrate an impacted right femoral neck
fracture.
The patient had suffered a recent fall, but no plain films of the
hip were obtained at that time.
Increased activity was also seen in the left femoral neck,
consistent with the patient's history of healed left femoral
neck fracture.
The kidneys are not visualized in the usual location.
There are several foci of intense activity in the pelvis near
the midline. These represent the calyces of the patient's
known horseshoe kidney.
Discussion:
MDP is taken up in proportion to bone turnover,
so the differential for increased osseous uptake of the tracer
is long.
The most likely etiologies in the femoral neck of this elderly demented
male with a
history of prostate cancer would be trauma or osseous metastasis.
Plain films confirm the diagnosis of fracture.
The adjacent femoral head has no uptake, most likely on the basis of
disruption of the perfusion by the fracture.
Followup:
The patient underwent right hip hemiarthroplasty.
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: bs100
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