Post Traumatic Soft Tissue Uptake on Bone Scan: A Case Study
Objective: Nuclear Medicine is often called upon to diagnose occult fracture as the cause of pain following trauma. Whilst primarily concerned with bony abnormalities, a bone scan can occasionally reveal soft tissue uptake of significant diagnostic value.
Method: A 90-year-old female presented with increasing right hip and thigh pain and unable to weight bear following two consecutive falls. It was noted that the patient was on anticoagulant therapy with an INR of 3.5. Ultrasound, X-Ray, and CT where performed with no evidence of focal haematoma or fracture. A three-phase bone scan was then requested to rule out occult fracture. The patient was injected with 880MBq Tc99m-MDP with flow and blood pool imaging of the hips performed followed by delayed whole body scan.
Results: A large hyperaemic area in the lateral right thigh extending inferiorly was demonstrated on early phase imaging. The delayed images confirmed significant soft tissue uptake that extended from the region of the right iliac crest inferiorly and laterally ending at the lateral right knee. No bony abnormality was demonstrated in this region.
Conclusion: These findings where consistent with a significant haemorrhage into the lateral compartment of the right thigh. This was considered most likely due to trauma in the setting of anticoagulant therapy. Although soft tissue in nature, in this case, a bone scan was able to provide a decisive explanation for this elderly patients pain. The results of the scan were then conveyed to the general surgical RMO for immediate review.