A 61 year old man with history of rheumatoid arthritis and hypertension presents with pain in left hip after a fall. X-ray of the pelvis did not show any fractures, but a sclerotic lesion in the right iliac wing was noted. A bone scan was recommended for further evaluation.

The whole body bone scan shows multiple foci of increased uptake in the pelvis, left chest wall, and the T5 vertebral body. The pelvic abnormalities were suspicious for metastatic disease.

The whole body FDG PET-CT found varying degrees of hypermetabolism at the sites of multiple fractures, at various stages of healing, corresponding to the bone scan findings, and suspicious for insufficiency fractures. No focal abnormal hypermetabolism was seen to suggest active neoplastic disease. On a follow up DXA scan patient was found to be osteoporotic, with a grade II wedge deformity of the T5 vertebral body. His osteoporosis was likely from chronic alcohol abuse and he was also found to have chronic alcoholic liver disease.

The whole body FDG PET-CT found varying degrees of hypermetabolism at the sites of multiple fractures, at various stages of healing, corresponding to the bone scan findings, and suspicious for insufficiency fractures. No focal abnormal hypermetabolism was seen to suggest active neoplastic disease. On a follow up DXA scan patient was found to be osteoporotic, with a grade II wedge deformity of the T5 vertebral body. His osteoporosis was likely from chronic alcohol abuse and he was also found to have chronic alcoholic liver disease.

1. http://www.springerlink.com/content/jq23mm975056j5m5/fulltext.pdf

2. http://www.ncbi.nlm.nih.gov/pubmed/16166836

3. http://www.jsnm.org/files/paper/anm/ams206/ANM20-6-11.pdf

This case was compiled by Dr. Niraj R Patel BCM