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SLIPPED CAPITAL FEMORAL EPIPHYSIS ON BONE SCINTIGRAPHY
Authored By: Peter Phan and Barry Siegel, Prof of Radiology.
Patient: 13 year old male
History: 13-year-old with boy with Hodgkin's Lymphoma.
Image Size:[small][as-submitted]

Fig. 1
Whole-body bone scintigraphy

Fig. 2
Bone scintigraphy spot images

Fig. 3
Radiograph of the hips

Fig. 4
Post internal fixation radiograph
Image Size:[small][as-submitted]

Findings: RADIOPHARMACEUTICAL: 20 mCi Tc-99m MDP i.v.

FocalLY increased uptake is seen along the physis of the left proximal femur. No additional areas of abnormal uptake are seen.
DDx: Slipped  femoral capital epiphysis
Diagnosis: Slipped  femoral capital epiphysis
General Discussion: The patient is a 13-year-old boy with stage IV Hodgkin's lymphoma, diagnosed two years ago.  He completed radiation to the upper thoracolumbar spine and chemotherapy over a year ago and is currently in remission. The patient now presents with two months of left hip pain.  The clinical concern is recurrent osseous metastatic disease.

In slipped capital femoral epiphysis (SCFE), the epiphysis displaces medially at the growth plate.  This condition is generally seen in adolescents, boys more often than girls and more often presents unilaterally.  SCFE is commonly diagnosed by plain radiographs, with the frog-leg view being most sensitive.  However, a bone scan may be helpful if radiographs are not revealing, especially in cases of bilateral displacement or there is suspected osteonecrosis [1].




References:

1.  Elgazzar, AH. Orthopedic Nuclear Medicine. Berlin: Springer-Verlag; 2004: 116.

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Additional Details:

Case Number: 101881Owner(s): Peter Phan and Barry Siegel, Prof of RadiologyLast Updated: 02-07-2013
Anatomy: Skeletal System   Pathology: Other
Modality: Conventional Radiograph, Nuc MedAccess Level: Readable by all users, writable by NucMed Certifiers
Keywords: bsnmACR: 00004.41460

Case has been viewed 41 times.
Certified by Barry Siegel on 06-13-2009

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