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Nuclear medicine (bone scan) - Note the evolution of osteomyelitis in a 4 month period. Image 1 - acute osteomyeltis, decreased uptake due to tamponade effect from mass effect. Image 2 - increased uptake due to increased osteoblast activity in the local region (chornic stage - no mass effect as necrosis of most both cortex and medulla and cloaca present).
CR - Background osteoporosis due to underlying condition of beta thalassaemia major. Degenerative changes in the right hip - thalassaemia related arthropathy. Severe periosteal reaction along the femoral diaphysis. Well defined lucencies in the proximal and distal femur, not present on previous xrays suggest abscess formation. Destruction of the lateral aspect of the distal femoral diaphysis (cloaca noted). Underlying soft tissue involvement should be considered.