Search

A 24-year-old female gymnast had a 3-month history of bilateral forearm pain. A Tc-99m MDP bone scan demonstrated focally increased activity in the radial shafts on blood pool and delayed images, characteristic of fatigue fractures. Fatigue fractures commonly occur in the lower extremities. Upper extremity fatigue fractures, in contrast, are uncommon and usually involve the humerus or ulna. Fatigue fracture of the radial shaft from gymnastic exercise has not been previously reported.

Separate imaging studies employing Tc-99m MDP, In-111 labeled leukocytes, and Tc-99m SC were performed in a patient receiving external beam radiation therapy to the mediastinum and left hemithorax. The leukocyte scan demonstrated greatly increased activity at the site of the radiation port. The bone marrow (sulfur colloid) scan was normal and the bone scan demonstrated only minimally increased activity in the irradiated region. The varying appearance of these scans may represent the difference in the early effect of radiation on bone and bone marrow elements.

Stress fractures are a common injury in long-distance runners, and typically involve the lower extremities. Although relatively rare, pubic ramus stress fractures also occur, primarily in female runners. Bone imaging visualized a pubic stress fracture and a tibial stress fracture in a female long-distance runner with groin pain. Pubic stress fractures should be considered in female runners who present with groin pain. Radionuclide bone imaging is useful in diagnosing these lesions.

On December 2, 1982, a permanent total artificial heart was implanted into the chest of a 61-year-old man with a progressive and irreversible cardiomyopathy. During the ensuing four-month hospitalization, a number of nuclear medicine procedures were obtained to assist in patient management. These procedures included gated cardiac radionuclide ventriculography, an I-123 iodoamphetamine scan for cerebral perfusion, and In-111 labeled leukocyte imaging. These radionuclide studies demonstrate the advantages of being able to monitor physiologic changes noninvasively and illustrate a potential role for nuclear cardiology in managing patients with a total artificial heart.

Leprosy is a disease that is widely distributed in underdeveloped tropical regions, with cases also occurring in the United States. The bone scan findings in a patient with leprosy who had developed a reactional state of the disease, erythema nodosum leprosum, are presented. His scan showed bilaterally symmetrical double stripe signs involving the distal tibias, similar to those seen in hypertrophic osteoarthropathy. Physicians should be aware that this reactive phase of leprosy can also produce the double stripe sign.

Accumulation of radioactive urine in a bladder diverticulum on a Tc-99m pertechnetate scan simulated uptake in a Meckel's diverticulum. The abnormal activity was present even following bladder catheterization and drainage. However, saline lavage washed the residual activity out of the bladder, and prevented a false-positive diagnosis. In addition to preventing false-positive studies, bladder lavage may increase the sensitivity of the test by allowing the detection of Meckel's diverticuli that are obscured by residual bladder activity.