Case Author(s): Jeff Chesnut, D.O. and Jerold Wallis, M.D. , 7/24/99 . Rating: #D2, #Q4
Diagnosis: Slipped capital femoral epiphysis with preserved perfusion
Brief history:
10 year old boy who experienced severe right hip pain while running.
Images:
Delayed limited bone scan of the hips and pelvis are shown
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Pinhole views of the hips are shown.
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A right hip radiograph is shown.
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Side-by-side view of the right hip on bone scintigram and plain radiograph
Full history/Diagnosis is available below
Diagnosis: Slipped capital femoral epiphysis with preserved perfusion
Full history:
10 year old boy who experienced severe right hip pain while running.
Radiopharmaceutical:
Tc-99m MDP
Findings:
The right femur demonstrated a slipped capital femoral epiphysis. The
epiphysis remains located within the acetabulum while the proximal
femoral metaphysis and shaft are displaced superiorly and posteriorly.
There is increased radiopharmaceutical activity at the right femoral
epiphysis as well as the proximal metaphysis adjacent to the fracture.
Also, the adjacent acetabulum demonstrates mildly increased radiopharmaceutical
activity.
The left hip is normal.
Discussion:
Bone scintigraphy is not used as a primary modality for the detection of
a slipped capital femoral epiphysis (SCFE). The utility of bone scintigraphy in
this case is to evaluate viablity of the epiphysis. An SCFE which has
preserved blood flow may respond very well to orthopedic repair, whereas
an SCFE without flow will eventually necrose and lead to arthritis.
Major teaching point(s):
Bone scintigraphy can evaluate retained perfusion to an SCFE and thereby
provide valuable prognostic information.
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: bs112
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