Nuclear Medicine Lending a Hand
A 60 yr old man presented to the emergency department with right hip pain radiating down the leg, febrile on admission and recently diagnosed with Klebsiella urosepsis by his GP. X-ray demonstrated severe right hip degenerative change. He had elevated WBC count and CRP, consistent with an acute infective process. He was treated with IV gentamicin in the interim.
Day 2: CT scan was performed and demonstrated three hypodense liver lesions and an inflammatory swelling of the right hindquarter, suggesting inflammatory myositis or necrotizing fasciitis. Gas was noted in the medullary cavity of the right iliac bone. Ultrasound excluded biliary calculi.
Day 5: WBBS was performed. Initial images demonstrated an area of photopenia in the region of the right hip joint and iliac bone with surrounding hyperemia, suggestive an inflammatory process. Delayed images had a corresponding photopenic defect.
Day 7: Gallium Scan was performed. 24 hour images showed increase soft tissue uptake around the right hip joint, suggesting presence of osteomyelitis and adjacent soft tissue component with septic arthritis.
Day 12: MRI showed inflammatory changes of the right hip. This concurred with the results of the bone and gallium scan showing osteomyelitis involving the right ilium and right proximal femur.
Both the WBBS and the Gallium Scan provided important information regarding the extent and intensity of the inflammation complementary to conventional imaging. Nuclear Medicine proved its value in assisting decision making regarding the patient’s management by defining the extent and nature of this patient’s disease.