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CALCANEAL STRESS FRACTURE
Authored By: Keith Fischer and Shane Inoue.
Patient: 85 year old female
History: 85 year old female: Pain in the left ankle and left foot for 6 months.
Image Size:[small][as-submitted]

Fig. 1
Blood flow images

Fig. 2
Immediate static and 3 hour delayed images

Fig. 3
Plantar 3 hour delayed

Fig. 4
Radiograph five weeks before bone scan

Fig. 5
Radiograph one year before bone scan
Image Size:[small][as-submitted]

Findings: There is mildly increased blood flow and blood pool in the left calcaneus. There is markedly increased activity in the left calcaneus on delayed bone scintigraphy images correlating to the compression fracture seen on the plain film one year before bone scan. In addition, there is mildly increased activity seen in the metatarsal region, most likely representing degenerative joint disease.

L foot XRAY one year before bone scan: There is a subtle cortical step-off at the superior aspect of the posterior calcaneus with a sclerotic line oriented vertically through the calcaneus. This is consistent with a nondisplaced extra-articular fracture.
DDx: 1. Trauma
2. Osteomyelitis
3. Tumor
Diagnosis: Calcaneal stress fracture
General Discussion: Abnormal 3 phase bone sintigraphy carries the differential diagnosis of trauma, osteomyelitis and tumor.
References: Mettler, FA, Guiberteau, MJ.  Essentials of Nuclear Medicine Imgaing, 5th ed.  Philadelphia, Saunders, 2006.
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Additional Details:

Case Number: 104689Owner(s): Keith Fischer and Shane InoueLast Updated: 02-07-2013
Anatomy: Skeletal System   Pathology: Trauma
Modality: Conventional Radiograph, Nuc MedAccess Level: Readable by all users, writable by NucMed Certifiers
Keywords: calcaneus, stress facture

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Certified by Keith Fischer on 11-02-2010

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