Bone infarction mimicking osteosarcoma as an incidental finding – a case report

Authors: Viera Rousková 1;  Otto Lang 2
Authors‘ workplace: Oddělení nukleární medicíny, Oblastní nemocnice Trutnov a. s., ČR 1;  Oddělení nukleární medicíny, Oblastní nemocnice Příbram, a. s., ČR 2
Published in: NuklMed 2018;7:32-35
Category: Casuistry


To present a SPECT/CT pattern of an incidentally detected bone infarction possibly mimicking osteosarcoma.

Case report:
84-y-old lady with a fracture of L3 was referred to our department for a bone scan. Images were acquired after injection of 800 MBq of 99mTc-HDP using a SPECT/CT gamma camera BrightView XCT with a flat panel (Phillips). We detected only mild degenerative changes of the spine without any increased bone metabolic turnover in the location of referred fracture. Unexpected patchy increased accumulation of the radiopharmaceutical was, however, clearly visible at the proximal part of the right tibia. SPECT/CT of this area was thus performed, which revealed intramedullary irregular well-defined shell-like sclerosis with relative central photopenia and well defined calcified margins without any periosteal reaction. We concluded this is and old bone infarction after consultation with radiologists.

We present a pattern of bone infarction which can mimic osteosarcoma. Bone scan appearance of bone infarction changes according to its development from accumulation defect to increased accumulation. Nevertheless, there is a risk of osteosarcoma development at the location of bone infarction. It is also necessary to distinguish it from osteomyelitis especially in patients with a sickle cell disease.

Key Words:
bone infarction, bone scan, osteosarcoma, SPECT/CT

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