Eur J Nucl Med Mol Imaging (2008) 35:1220 DOI 10.1007/s00259-008-0760-y
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Secondary hypertrophic osteoarthropathy on bone scintigraphy as a diagnosis of vascular prosthesis infection Anne-Sophie Hambye & Catherine A. Castaigne
Received: 2 January 2008 / Accepted: 21 February 2008 / Published online: 8 April 2008 # Springer-Verlag 2008
Secondary hypertrophic osteoarthropathy (HOA) is mostly associated with thoracic diseases [1]. Usually bilateral and symmetric, it is characterized by diffuse periosteal and periarticular uptake along the long bones and joints on bone scintigraphy. Unilateral HOA is much less common. Its adequate recognition on a bone scintigraphy is of major importance in patients with previous arterial graft surgery in whom it might constitute the presenting symptom of a graft infection [2–4]. We present the case of a 72-year-old patient with a history of aorto-bifemoral bifurcation prosthesis in 2004. In 2007, he consulted because of asymmetrical inflammatory lower limb edema, sporadic episodes of chills without documented fever, and low back pain. Based upon a positive hemoculture for a Group-C Streptococcus, the diagnosis of erysipelas with secondary septicemia was made. A 99m Tc-HDP bone scan, performed to rule out spondylodiscitis, showed a diffusely increased uptake of the left lower limb bones and joints, including the sacroiliacal (figure, left) but no spondylodiscitis on singlephoton emission computed tomography (SPECT). The diagnosis of unilateral HOA, possibly secondary to aortic prosthesis infection, was proposed. On 99mTc-anti granulocytes SPECT (Scintimun® Granulocyte), a highly increased uptake was observed from the distal aorta to the left femoral artery, perfectly matching the course of the left graft side on the merged CT–SPECT images (figure, right). At surgery, a massive infection of the left part of the graft was confirmed.
A.-S. Hambye (*) : C. A. Castaigne Avenue Max Buset 34, 7100 La Louviere, Ht, Belgium e-mail:
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99m
Tc-HDP bone scan showing a diffusely increased uptake of the left lower limb bones and joints, including the sacro-iliacal (left). 99m Tc-anti granulocytes SPECT showing a highly increased uptake from the distal aorta to the left femoral artery (right)
Unilateral HOA is rarely observed on bone scintigraphy. In patients with previous vascular prosthesis surgery, it could suggest the possibility of a graft infection.
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