Sinus Tarsi Syndrome is a cause of chronic ankle instability and pain. MRI of the ankle has been the modality of choice for diagnosing the condition. However, SPECTCT offers an alternate modality for diagnosing and evaluation of the condition. We present the case of a footballer who was suffering from chronic right leg pain despite receiving physiotherapy. He was being managed as a case of a chronic ankle sprain. Meanwhile, he was referred to the department as radiology for MRI of the ankle could not be performed as the patient felt claustrophobic. The patient subsequently underwent a 99mTc-MDP Bone scan. He was diagnosed to be suffering from sinus tarsi syndrome as it showed a characteristic pattern noted on 99mTc-MDP Bone scintigraphy. This case report reveals the potential of SPECT-CT as an alternative in the evaluation of chronic ankle sprain to MRI in segment of cases where MRI is not performed due to various reasons...

Background: Solitary orbital lesion on bone scan is not uncommon but difficult to diagnosis. The objective was to characterize the solitary orbital lesion demonstrated on bone scan.Materials and Methods: Ten orbital lesions on bone scan were followed up, evaluated and compared with CT.Results: Compared with bone scans taken 6-49 months later, 6 lesions remained stable, 3 had decreased uptake and 1 progressed. So, 9 lesions were considered benign, 6 of which showed groundglass density on CT indicating benign fibro-osseous lesions, 3 was normal on CT.Conclusion: Most solitary orbital lesions detected on bone scan are benign and fibro-osseous lesions might be the cause of uptake.

A 65 year-old overweight man with a history of prostate cancer was referred to our nuclear medicine department for bone scanning. Anterior projection images showed two small foci of increased radiotracer uptake corresponding to the anterior arcs of the right and left sixth ribs, which were interpreted as suspicious for metastatic involvement. Eight months later the patient was referred for follow-up bone scan. In the follow-up scan, those two foci of abnormal radiotracer activity were outside the limits of the bony structures of the chest. In fact, those foci changed their position and were due to radiotracer uptake by the enlarged breasts of this gentelman (Gynecomastia). Previously, it has been just one report concerning radiotracer uptake in the breasts of a man. Based on our case report, this abnormal finding is not exclusively observed in women and it can be also seen in men who suffer from gynecomastia. Physical examination in these settings can be extremely helpful. Oblique, lateral and SPECT (Single Photon Emission Tomography) views can also confirm the extraskeletal origin of radiotracer uptake.

Melioidosis is a potentially fatal infectious disease occurring predominantly in the tropics, caused by a Gram-negative, motile, rod shaped obligatory aerobic non-spore forming bacillus, Burkholderia pseudomallei. It can produce localised or disseminated disease largely affecting immunocompromised patients. It is a challenge to identify melioidosis early as this disease can manipulate host’ s cellular immune response to escape detection. Although musculoskeletal involvement in melioidosis is said to be the predominant manifestation, reports have shown widespread involvement in the form of abscesses in lung, liver and spleen etc. It predominantly occurs in patients with diabetes mellitus or those suffering from chronic alcohol abuse, cirrhosis, smoking, chronic lung disease or patients on longstanding corticosteroid use. We present a 43-year-old diabetic male with fever and headache of 5 months duration, abdominal and left sided hip pain with difficulty in walking for 3 weeks. 99mTc-MDP three phase bone scan revealed increased tracer uptake in left femur leading to a diagnosis of focal osteomyelitis. In view of dull aching, intermittent abdominal pain, further investigation was carried out. Contrast enhanced CT abdomen showed hepatosplenomegaly with rim enhancing tiny lesions scattered in liver and spleen suggesting possibility of micro abscesses. Serial blood cultures grew Gram-negative bacilli, which was later identified as B. pseudomallei. Patient was subsequently started on meropenem, doxycycline and cotrimoxazole. Bone scan was the first investigation to identify the pathology and mooted further investigation to identify visceral involvement guiding appropriate management. He was followed up for a period of 6 months and had an uneventful recovery.

Pigment villondular synovitis (PVNS) is a rare synovial condition. The nature of this disorder is usually characterized as benign; however, malignant transformation has also been reported. MRI is the diagnostic modality of choice in evaluating this entity, revealing low T1 and T2 weighted signals and blooming artifact on gradient echo sequences. Three-phase 99mTc-MDP bone scan has been infrequently used to assess these lesions; and a varied pattern on three phase bone scans has been reported. In the present case, we report a case of diffuse type PVNS lesion of the knee, evaluated with three-phase 99mTc-MDP bone scan. This lesion had a progressive nature. Flow and blood pool images revealed minimal activity in the lesion, with increased radiotracer uptake on delayed images. After surgical resection, the patient’ s diagnosis of a PVNS was confirmed. Although, the pattern of PVNS has been characterized as more prominent on vascular and blood pool images, other patterns such as limited arterial and venous perfusion, as observed in our case, is also possible. In addition, SPECT-CT, as in this case, provided valuable information regarding the extent of joint involvement.

A 50-year-old man with postprandial abdominal pain, weight loss, and generalized body ache was referred to Nuclear medicine department for a whole body bone scan to look for any malignancy. Clinical examination did not reveal any specific positive findings. He underwent a Technetium-99m Methylene Diphosphonate (99mTc-MDP) bone scan which showed no obvious bone pathology. But there was abnormal increased MDP uptake in the entire transverse colon, splenic flexure, and sigmoid colon prompting further evaluation. Contrast-enhanced computed tomography (CECT) was performed and it suggested superior mesenteric vein thrombosis. Thus MDP uptake in bowel loops reflects the extra osseous tracer uptake at the cellular and tissue level due to chronic inflammation and plasma protein binding due to edema. Colonoscopy and segmental biopsy were noncontributory.