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Dr. Manish Thangaraj delivered this lecture at Alagappa University. Its related to Bones course in Medical Science. Its main points are: Case, Radiograph, Multiple, Sclerosis, Diagnosis, Avascular, Necrosis, Femoral, Scintigram, Osteonecrosis
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68-year-old man with H/O fall. Pain right hip. X-ray normal. There is also H/O of pneumonia and Klebsiella bacteremia 1 month back
There is vague, increased activity in the intertrochanteric region of the right femur.
There is increased activity at the L4 and L5 vertebral body levels. These findings suggest a disk-centered process.
X-ray shows loss of disk height at L4-5 with adjacent vertebral body endplate destruction and sclerosis.
Intense uptake of the radiotracer in the sacral region involving both wings of the sacrum as well as the interposed sacrum (Honda sign). It is characteristic for sacral insufficiency fracture.
There is also increased uptake in the inferior pubic ramus and multiple foci in the left ribs arranged in two curved lines.
Sacral insufficiency fractures are stress fractures
Elderly woman with no H/O malignancy, who has had low back/pelvic pain since a fall two weeks ago. Radiographs demonstrate only degenerative changes in the lumbar spine, and old lumbar compression fractures.
Increased uptake distributed in the sacrum in transverse and linear manner. There is also increased uptake in the SI joints. Picture typical for sacral insufficiency fracture.
88-year-old demented man with a history of prostate cancer had been complaining of right leg pain. To evaluate for possible osseous metastases.
Increased activity in the right intertrochanteric region and photon – deficient right femoral head.
Increased activity was also seen in the left femoral neck which is in keeping with H/O of old fracture.
Note the kidneys
18-month-old boy, who had a twisting injury to the right leg 7 days ago and who now refuses to bear weight on the right leg. Flow
Perfusion Delayed
Delayed
Anterior radionuclide angiogram and immediate static image reveal mild hyperperfusion and somewhat greater hyperemia in the region of the entire right tibial shaft
Anterior and right and left frog-leg lateral delayed images show moderately increased uptake in the right tibia. Normal Radiograph Dx is spiral fracture of the right tibial shaft. docsity.com
65 year old male with laryngeal carcinoma (resected). To rule out metasases.
Multiple foci of increased uptake in the axial and appendicular skeleton, which are most consistent with bone metastases.
A curvilinear region of absent uptake is seen over the left kidney on the anterior view which correlates with residual barium from an upper GI performed one day prior to bone scintigraphy
61-year old woman with breast cancer diagnosed four years previously. She refused surgery at that time and now presents with a large fungating mass involving the right breast. The tumor is adherent to the chest wall.
A large focal area of intensely increased uptake is identified in the right breast. This corresponds to the known fungating partially calcified tumor mass.
A 47 year-old white male presented with coughing for three months, accompanied by painful swollen knees, legs and ankles. The lung washing was positive for bronchial adenocarcinoma of the lung.
Bone scan revealed increased uptake in the lower extremities consistent with hypertrophic pulmonary osteoarthropathy.
This 66 year old woman with known small cell carcinoma. She was being evaluated for metastatic disease to plan therapy.
There is abnormal activity in the chest, at the midline and slightly more prominent to the left of midline. The activity is more prominent on the anterior than on the posterior view. On oblique views, it appears to be deep to the sternum. The skeleton itself is normal. No evidence of osseous metastases. Follow-up Ct showed soft tissue infiltration of the superior mediastinum docsity.com
