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1. Acute osteomyelitis

Figure 62-1

Acute osteomyelitis.

This 7-year-old boy presented with fever and a limp. A-C. Anterior blood pool image (A) and anterior (B) and lateral (C) delayed images from bone scintigraphy show the classic flame-shaped pattern of uptake in the distal right tibial metaphysis and physis. Hyperemia results in asymmetry in uptake throughout the right lower leg and foot relative to the left.

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2. Infarctive osteomyelitis

Figure 62-2

Infarctive osteomyelitis.

This 2-year-old boy presented with fever and right arm pain. A. A posterior scintigraphic image shows prominent uptake in the proximal aspect of the ulna and reduced uptake throughout the remainder (arrow), including lack of normal uptake in the distal physis. B. A sagittal T1-weighted MR image shows multiple areas of hypointensity (arrow) in the ulna. C, D. A large amount of hyperintense subperiosteal fluid (arrows) is visible surrounding the ulna on these fat-suppressed T2-weighted images. The elevated periosteum is hypointense. The medullary portion of the ulna is hyperintense due to edema. There is extensive hyperintense edema in the soft tissues of the forearm. Effusions are present in the wrist and elbow (R, radius). E. An axial contrast-enhanced fat-suppressed T1-weighted image shows hypointense subperiosteal fluid (arrow), enhancement of the elevated periosteum, and extensive enhancement of adjacent soft tissues. Surgical exploration demonstrated pus in the subperiosteal space and in the ulnar medullary cavity. Cultures grew Methicillin-resistant Staphylococcus aureus.

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3. Chronic osteomyelitis

Figure 62-3

Chronic osteomyelitis.

A. Bone scintigraphy shows marked uptake in the proximal aspect of the right tibia. B. The metaphysis is sclerotic on CT. There is a small hypoattenuating abscess cavity (arrow) that contains a sequestrum.

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4. Chronic recurrent multifocal osteomyelitis

Figure 62-4

Chronic recurrent multifocal osteomyelitis.

This 13-year-old boy has chronic right femur pain. There is mixed lucency and sclerosis in the diaphysis on an AP radiograph. The bone is expanded due to cortical thickening. There is periosteal new bone formation.

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5. Septic arthritis; scintigraphy

Figure 62-5

Septic arthritis; scintigraphy.

A. An anterior blood pool bone scintigraphy image shows left hip photopenia (arrows) due to a distended joint. B. There is prominent uptake (arrows) in the acetabulum and proximal femur on the delayed image.

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