Osteomyelitis - Tc99m MDP SPECT/CT

Case contributed by Dr. Chris O'Donnell

Presentation

Elderly diabetic with a foot ulcer over the 5th metatarsal head - osteomyelitis?

Patient Data

Age: 80 years
Gender: Male

NM bone scan and co-registered CT

Focus of intense isotope accumulation superimposed over the 5th metatarsal head. In the context of clinical sepsis and given the presence of adjacent subcutaneous gas, findings indicate established osteomyelitis.

Soft tissue swelling and subtle soft tissue gas over the 5th metatarsal head. Note vascular calcification indicating advanced small vessel atherosclerosis. No overt bone erosion thus bone scan has been very helpful in diagnosis.

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