Case Author(s): Hamid Latifi/Keith Fischer , 6/9/95 . Rating: #D3, #Q5
Diagnosis: Septic arthritis (right hip)
Brief history:
34 year old woman with fever of unknown source.
Images:
Anterior and posterior delayed whole-body images from bone scintigraphy.
View main image(bs) in a separate image viewer
View second image(ga).
Anterior and posterior whole-body images obtained 48 hours after injection of Gallium-67.
Full history/Diagnosis is available below
Diagnosis: Septic arthritis (right hip)
Full history:
34-year old woman who was involved in a
motor vehicle accident and suffered multiple thoracolumbar
fractures. The patient had two posterior spinal fusion rods placed for stabilization of the spine. Subsequently, the patient had
fevers. Bone and gallium scintigraphy were performed to
evaluate for source of fever.
Radiopharmaceutical:
Tc-99m MDP and Ga-67 Citrate
Findings:
The bone scintigraphy shows multiple sites
of increased uptake in the thoracic and lumbar spine at sites
of the patientıs fractures and recent spinal fixation surgery.
Gallium scintigraphy shows an area of markedly increased
uptake in the right hip, which correlates with right hip joint
fluid seen on the CT examination of 5-31-95.
Discussion:
This case demonstrates the classical
findings of infection on gallium scintigraphy with normal
bone scintigraphy and markedly abnormal gallium
scintigraphic findings.
Followup:
Joint aspiration of right hip was positive for
Staphylococcus aureus
Major teaching point(s):
The marked discordance between the
bone and gallium scintigraphic findings in the right hip is
strongly indicative of infection in that region which was
subsequently proved by joint aspiration. This case also
demonstrates that bone scintigraphy is necessary for correct
interpretation of gallium scintigraphy in areas where
suspected bone abnormalities are present such as in this
patientıs spine. Without bone scintigraphy, interpretation of
gallium findings in this patientıs spine would have been
nearly impossible.
ACR Codes and Keywords:
References and General Discussion of Gallium Scintigraphy (Anatomic field:Skeletal System, Category:Inflammation,Infection)
Search for similar cases.
Edit this case
Add comments about this case
Return to the Teaching File home page.
Case number: ga004
Copyright by Wash U MO
