Nuclear Imaging BONE SCAN
3-5-91
Indication: Evaluate for trauma
Procedure and findings. Multiple gama camera images of the axial [trunk] and proximal appendicular [limbs] skeleton in the anterior [front] and posterior [back] projections were obtained following 2.1 millicuries of technetium 99m HDP.
There are an extensive number of focal abnormal areas of nuclide accumulation of intense type. These include multiple bilateral ribs, the costovertebral [where ribs and vertebra come together] aspects of several of the thoracic [upper] vertebral bodies, the L1 [lower] vertebral body, both sacroliac joints, the distal right femoral diaphysis, both knees and both ankles, the right greater than the left.
Correlative radiographs are obtained of the lumbar spine and of the right femur [leg bone] which reveal compression fracture; minor, superior and plate of L1, and shaggy, irregular periosteal ossification along the distal femoral diaphysis, and metaphysis primarily ventrally. [calcification showing where bones were broken and have healed].
The patient has a history of trauma. Most likely the femoral periosteal reaction reflects a response to a subperiosteal hemorrhage and the activity in L1 correlates perfectly with the compression fracture which is presumably traumatic.
The presumptions is that the other multiple areas of abnormal activity also relate to previous trauma. Additional possibilities would be neoplastic bone disease, widespread disseminated infectious bone disease or multiple bone infarcts from abnormal hemoglobin.
CONCLUSION: Multiple areas of abnormal scintigraphic [actinographic?] accumulation, some of which are radiograph for differential as discussed above.
W. Campbell Walker M.D./mjt
Dictated 3-5-91
Transcribed ?-5-91
Lee Memorial Hospital