tibial acute Osteomyelitis

            Female 3 year old, presents trauma after jumping in the trampoline and limp in the left leg. Fever and pain in the left side. X-rays of both legs and hips ultrasound were normal. Underwent bone scan. Note increased uptake and thickening in the superior left tibial metaphysis (arrows). Mild diffuse nonspecific activity in the bones of left side. She was treated with antibiotics and operated on draining the physis. Cultures were negatives.

            Palestro CJ et al, discusses the role of bone scan in musculoskeletal infections and comment that "Three-phase bone imaging, readily available and relatively inexpensive, is very accurate in unviolated bone. In the setting of underlying osseous abnormalities,  however, the specificity of the test decreases. Four-phase bone, sequential bone/gallium, and labeled leukocyte imaging all have been used in an effort to enhance specificity."

        Coll C et al concluded after evaluating 38 patients that "Three-phase bone imaging is a helpful tool in the diagnosis and assessment of acute osteomyelitis in pediatric population. A positive Three-phase bone scan is highly accurate for acute osteomyelitis and a negative one rules it out securely

References:

1.- Palestro CJ, Love C. Radionuclide imaging of musculoskeletal infection: conventional agents. Semin Musculoskelet Radiol. 2007 Dec;11(4):335-52.

2.- COLL C, Claudia; CIFRAS, José Luis; MASSARDO V, Teresa y MOYA S, Hernán.CINTIGRAFIA OSEA TRIFASICA CON Tc-99m MDP EN EL DIAGNOSTICO Y MANEJO DE INFECCIONES OSTEOARTICULARES AGUDAS EN NIÑOS . Rev. chil. radiol. 2002, vol.8, n.2, pp. 83-88.

 

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