PMC3407585_01
Right leg simple X-ray shows periosteal elevation.
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X-ray of her left leg revealed periosteal reaction of diaphysis of left tibia with soft tissue swelling (Figure 1).
Bone scintigraphy three hours after i.v. injection Tc99m shows significantly increased uptake in right tibia (white arrow) and slightly increased uptake in the left tibial bone (black arrow).
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Isotope bone scan revealed increased uptake on the late films along the left tibial bone (Figure 2).
A. Bone scintigraphy three hours after i.v. injection Tc99m show active pathology in the left tibia and, B. in entire length of the left humerus.
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Isotope bone scan revealed active bony pathology in nearly all parts of the left humerus and left tibial shaft (Figure 3).
A. Coronal STIR MRI demonstrated tibial marrow edema in the shaft and surrounding soft tissue, also note minor edema of right tibia were in favor of osteomyelitis. The arrow shows site of previous bone biopsy of right tibia. B. Axial T1 weighted image of left leg reveal decrease in signal intensity in the tibial marrow, periosteal elevation and edema of soft tissue.
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MRI of right tibial bone showed an increase in signal intensity on STIR sequence at the mid shaft, however, there was no evidence of inflammatory change in the surrounding soft tissue structures (Figure 4).