Classical acute osteomyelitis with a negative bone scan

Abstract

Clinically and pathologically acute haematogenous osteomyelitis displays the characteristics of a typical inflammatory reaction. Local blood flow is increased, the capillaries are dilated and become leaky. These vascular features favour the development of a positive scintiscan following the introduction of a boneseeking radiopharmaceutical (Van Dyke et al., 1965; Garnett et al., 1975). Clearly, the vascular changes will precede any radiologically detectable alterations in bone structure. Accordingly, skeletal scintigraphy is now recommended as a sensitive test to help in the early diagnosis of osteomyelitis (Duszynski et al., 1975; Gilday et al., 1975; Majd and Frankel, 1976; Treves et al., 1976). The purpose of this report is to draw attention to the fact that proven severe acute osteomyelitis in a major long bone need not be associated at a preradiographic stage with a greater than normal accumulation of bone-seeking radiopharmaceutical either in the bone itself or in the surrounding soft tissue. A previously healthy, 11 -year-old boy developed a “flu”- like illness with malaise, diarrhoea and fever. On the second day of his illness he complained of throbbing pain in his right upper arm. There was no known antecedent trauma. Three days later the arm was hot and swollen, marked tenderness was localized over the proximal humerus, but the shoulder could be moved passively throughout its range.