Presentation
Right thigh pain.
Patient Data
Radiographs of the right femur are normal.
Tc-99m MDP bone scintigraphy
Anterior and posterior views from a lower body bone scan (single delayed phase) performed using 25 mCi of Tc-99m MDP IV.
There is an ill-defined focus of intense radiotracer accumulation in the posterior-medial soft tissues of the right thigh.
No evidence of bone stress injury or other significant osseous abnormality is present.
Axial T2 fat sat images show a intrasubstance tear of the semitendinosus muscle with surrounding soft tissue edema.
Small amounts of additional edema is present in the rectus femoris, vastus medialis, adductor magnus and adductor brevis muscles represent muscle strains.
Coronal STIR shows similar findings of multiple muscle injurys, most severely affecting the semitendinosus muscle.
Coronal T1 images demonstrates subtle increased T1 signal in the semitendinosus muscle injury consistent with a component of hemorrhage.
Case Discussion
When muscle damage occurs, the subsequent inflammation, edema and/or hemorrhage often leads to soft tissue deposition of bone imaging radiotracers. Tc-99m MDP and other bisphosphonates localize within the site of soft tissue injury, depending on the increased blood flow (hyperemia) and the amount of iron and calcium present.
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