case_images: PMC3628269_01
case_images: A 4-year-old male child presented with weakness of few days in lower extremities and inability to bear weight. There was mild fever. Plain radiograph was unremarkable; (a) A working diagnosis of osteomyelitis of femur was made clinically. Three phase bone scan revealed diffuse increased tracer localization in the distal shaft of right femur (>) and mid shaft of left femur (<); (d) Perfusion and blood pool images did not favor the diagnosis of osteomyelitis; (b,c) Hematologic work up was suggested suspecting this to be bone cortical infarcts. Subsequent work up revealed acute myeloid leukemia
case_images: IJNM-27-59-g003.jpg
case_images: PMC3628269_01_IJNM-27-59-g003.jpg
case_images: F3
case_images: Hematologic work up revealed acute myeloid leukemia [Figure 3].
case_images: A known case of acute T cell lymphoblastic leukemia on treatment underwent allographtic stem cell transplantation. His hemogram was as follows: Hemoglobin 10.2 g/dL, red blood cell 2.22 10^6/uL (N 4.50-6.50), white blood cells=200/cmm (N 4000-10000) Neutrophils 21.6% Lymphocytes 47.4%, Monocytes 30.6%, Eosinophils 0.4%, Basophils 0%. He was on steroid therapy. He presented with pain in the shoulders bilaterally. Bone scan revealed diffuse uptake of radiotracer in the head of shoulder bilaterally suggesting osteonecrosis
case_images: IJNM-27-59-g004.jpg
case_images: PMC3628269_01_IJNM-27-59-g004.jpg
case_images: F4
case_images: Bone scan revealed diffuse increased tracer uptake in the head of humerus bilaterally suggesting osteonecrosis [Figure 4].
case_images: A 67-year-old known case of chronic myeloid leukemia had backache. Plain radiograph was normal. Bone scan revealed D12 vertebra showed linear uptake suggesting osteoporotic collapse. Whole body study revealed diffuse increased tracer localization in the axial and appendicular skeleton. Hyperactive bone marrow was probably responsible for such a pattern that simulated metabolic bone disease. Please note diminished tracer localization in the kidneys
case_images: IJNM-27-59-g005.jpg
case_images: PMC3628269_01_IJNM-27-59-g005.jpg
case_images: F5
case_images: This is related to diffusing bone marrow involvement or underlying metabolic bone disease [Figure 5].