Osteomyelitis. (A) Anterior and (B) oblique views of the left forefoot of a 61-year-old man with diabetes with approximately 1 month of left fourth toe.

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Osteomyelitis. (A) Anterior and (B) oblique views of the left forefoot of a 61-year-old man with diabetes with approximately 1 month of left fourth toe swelling and redness. Note the scalloped erosive appearance of the lateral diaphysis of the left fourth middle phalanx (arrow) best visualized on the oblique view. There is significant soft tissue swelling of the lateral left fourth toe. The findings are suggestive of osteomyelitis. (C) Plantar view of dynamic images of both feet from a conventional three-phase bone scan starting immediately after injection of 25.5 mCi of Tc99m-MDP and displayed at 6 seconds per frame for a total of 2 minutes. Note first arrival of radiopharmaceutical in the left foot on image number 6. There is early focal intense flow phase activity overlying the left fourth toe starting at image 7, with significant arrival of radiopharmaceutical in the similar region of the right foot much later in image number 11. (D) Plantar and bilateral lateral views of the feet in both the blood pool (BP) phase and delayed (DEL) phase of the three-phase bone scan. Because the feet were placed in nonstandard locations, left in front of right secondary to patient factors, the images are carefully labeled as to foot and view. There is strong focal uptake over the left fourth proximal and middle phalanges on both plantar and lateral views, best seen on the delayed plantar view. The strong positive uptake in all three phases over these two bones is consistent with osteomyelitis. The bone scan indicated infection in the proximal phalanx that showed no significant changes on the radiographs. Infection in both bones was confirmed after amputation. Source: Musculoskeletal Scintigraphy, Basic Musculoskeletal Imaging Citation: Tehranzadeh J, MD. Basic Musculoskeletal Imaging; 2016 Available at: https://accessphysiotherapy.mhmedical.com/DownloadImage.aspx?image=/data/Books/1788/ch20fg10b.png&sec=123934881&BookID=1788&ChapterSecID=123773279&imagename= Accessed: March 01, 2018 Copyright © 2018 McGraw-Hill Education. All rights reserved