On bone scan, osteomyelitis is typically characterized by increased blood flow and hyperemia on early phase imaging, with increased tracer uptake (osteoblastic activity) on delayed phase imaging. SPECT/CT is useful to better characterized the finding, increasing the sensitivity and specificity of the diagnosis. Focal uptake in bone adjacent structural changes on CT are often encountered (e.g. periosteal reaction, cortical erosion), as in this case. CT changes in the bone may not be present, however, as bone scan abnormalities can precede CT or plain film abnormalities by some weeks.