Joint Program in Nuclear Medicine

Findings, case of Diabetic with a Non-healing Ulcer

Imaging Findings

Radiography, three phase bone scan and gallium scan were performed.

Radiograph

The radiograph shows osteopenia of the first digit, soft tissue swelling and bone resorption of the first toe.

Three Phase Bone Scan

The flow phase of the three-phase bone scan demonstrates diffuse increased flow to the left foot with focal accumulation in the first digit (the arrow shows the accumulation). On the tissue phase, there is marked asymmetry with increase activity in the left foot. In addition, there is mild localization in the first digit (shown by arrow). The delayed images demonstrate focal uptake at the left first MTP joint and first interphalangeal joint (shown by arrows).

Gallium Scan

The gallium scan (bottom two images) demonstrates focal increased tracer uptake in the left first toe (shown by arrow). The intensity of the gallium uptake on the bottom two images is greater than that of the delayed bone scan on the top two images.

The Full Case Report

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J. Anthony Parker, MD PhD, Tony_Parker@CareGroup.Harvard.edu