Osteomyelitis on Three-Phase Bone Scan
Provided clinical image
Question
A three-phase bone scan shows increased uptake in ALL three phases (flow, blood pool, and delayed) in a painful, swollen extremity following trauma. No radiographic fracture is seen. This pattern is most characteristic of:
- AOsteomyelitis
- BCellulitis
- CComplex Regional Pain Syndrome (CRPS / RSD)
- DDeep vein thrombosis
Show the answer and explanation
A. Osteomyelitis
Osteomyelitis characteristically shows increased uptake in ALL THREE phases of bone scintigraphy: (1) FLOW phase — increased radionuclide angiogram reflecting hyperemia; (2) BLOOD POOL phase — increased activity from vascular pooling in inflamed tissue; (3) DELAYED phase — increased bone uptake from osteoblastic activity and periosteal reaction. This tri-phasic positivity is the hallmark of osteomyelitis. Cellulitis shows increased flow and blood pool phases but NORMAL delayed phase (soft-tissue hyperemia only, no bone involvement). CRPS can show diffuse periarticular uptake on all three phases but in a different distribution and clinical context. DVT does not significantly affect bone scan phases.
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