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.


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.


Tc-99m MDP and Ga-67 Citrate


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.


This case demonstrates the classical findings of infection on gallium scintigraphy with normal bone scintigraphy and markedly abnormal gallium scintigraphic findings.


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)

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Case number: ga004

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