Presentation
Fevers and elevated CRP. Non-weight bearing right leg.
Patient Data
Increased vascularity in the region of the right ankle on blood flow and blood pool images consistent with active inflammation.
Asymmetry of tracer uptake in the distal tibial physis, with abnormal increased uptake extending to the metaphysis (flaring). Appearances are concerning for osteomyelitis.
Uptake elsewhere is physiological only.
Blue circles denoting the increased accumulation of tracer on the blood pool images, consistent with local hyperemia.
Blue annotations on the delayed phase images outlining the abnormal physeal and metaphyseal uptake in the right distal tibia.
Significant bone marrow edema through the distal tibial physis and surrounding tissues, with abnormal enhancement. Crossing from the metaphysis into the physis, there is a well circumscribed T2 hyperintensity with peripheral enhancement consistent with a Brodie abscess. Abnormal periosteal enhancement.
Case Discussion
This case demonstrates the typical "three phase positive" appearance of osteomyelitis, that is increased blood flow, hyperemia on blood pool and delayed phase uptake. Asymmetric physeal uptake and flaring of tracer into the metaphysis is a common pattern of osteomyelitis on pediatric bone scan.
In infants and toddlers, localization of pathology can be difficult, with presentations often non-specific. In this child with a right-sided limp and concern for underlying infection, bone scan was able to localize the site of infection to the right ankle with MRI subsequently performed for confirmation. As MRI often requires sedation, which is not without risk, a bone scan can be a useful first step in their management.
Unable to process the form. Check for errors and try again.