Bone scintigraphy for the evaluation of possible osteomyelitis in the lower extremity leads to the detection of a brain abscess.

A 17-month-old boy presented with fever and lethargy for 2 days. A complete physical examination rendered no results to explain the source of the fever. Laboratory tests only showed leukocytosis, whereas CT scans of the chest, abdomen, and pelvis were unrevealing. Because the patient refused to walk, possible osteomyelitis of the lower extremities was suspected by referring physicians, and 3-phase bone scintigraphy of the lower extremities was acquired to confirm the suspicion. The bone-scan images showed no abnormal activity in the lower extremities. However, there was increased activity in the region of the mastoid of the right temporal bone. This finding prompted subsequent head CT scan that showed opacification of the middle ear cavity and mastoid air cells with destruction of mastoid bone, suggestive of otomastoiditis and possible osteomyelitis as a complication. In addition, CT showed a large right cerebellar abscess.

[1]  J. Brazier.  Human infections with Fusobacterium necrophorum. , 2006, Anaerobe.

[2]  M. Cohenpour,et al.  Thoracic cage uptake in bone scintigraphy secondary to lung abscess with extrapleural invasion. , 2006, Clinical nuclear medicine.

[3]  D. Rosenfeld,et al.  Jugular thrombophlebitis complicating bacterial pharyngitis (Lemierre's syndrome) , 2005, Pediatric Radiology.

[4]  E. Silverman,et al.  Hepatic abscess detected on a three-phase bone scan. , 2002, Clinical nuclear medicine.

[5]  M. Carli,et al.  Langerhans’ cell histiocytosis: temporal bone involvement , 2001, The Journal of Laryngology & Otology.

[6]  Y. Shiau,et al.  Simultaneous Tc-99m MDP and Ga-67 citrate uptake of benign lymphoid hyperplasia in the mastoid region. , 2001, Clinical nuclear medicine.

[7]  T. Hirano,et al.  Chronic mastoid sinusitis mimicking metastatic disease demonstrated by Tc-99m HMDP bone scintigraphy. , 1998, Clinical nuclear medicine.

[8]  P. Saadeh,et al.  Tc-99m MDP uptake in Staphylococcus aureus paraspinal abscess. Value of bone SPECT and reprojectional display in preoperative guidance. , 1997, Clinical nuclear medicine.

[9]  B. Thompson,et al.  Evaluation of Temporal and Facial Osteomyelitis by Simultaneous In-WBC/Tc-99m-MDP Bone SPECT Scintigraphy and Computed Tomography Scan , 1995, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[10]  J. Cisek,et al.  Lemierre syndrome: the forgotten disease. , 1993, Annals of emergency medicine.

[11]  A. Moallem,et al.  Nonspecific Tissue Accumulation of Diffusible Radionuclide Imaging Agents in Areas of Inflammation , 1992, Clinical nuclear medicine.

[12]  R. A. Holmes,et al.  Serendipitous detection of intrarenal abscesses on technetium-99m MDP imaging while evaluating a foot ulcer. , 1988, Clinical nuclear medicine.

[13]  E. Fishman,et al.  CT Detection of Sacral Osteomyelitis Associated with Pelvic Abscesses , 1988, Journal of computer assisted tomography.

[14]  E. Goodman,et al.  Bone Scintigraphy in the Diagnosis of Mastoiditis , 1981, Clinical nuclear medicine.

[15]  A. Aviel,et al.  Malignant external otitis: The diagnostic value of bone scintigraphy. , 1981, The Laryngoscope.

[16]  F. R. Curtis,et al.  Penicillin in the treatment of uncomplicated gonorrhea. , 1950, Lancet.

[17]  A. Lemierre.  ON CERTAIN SEPTICÆMIAS DUE TO ANAEROBIC ORGANISMS , 1936 .