We present images of an 83-year-old female with a history of osteoporosis and bilateral total knee replacement arthroplasty, referred for bone scintigraphy and single-photon emission computed tomography (SPECT)/computed tomography (CT), owing to left knee pain. No trauma to, or intense exercise of, the knee was reported. The bone scan and SPECT/CT revealed a focally increased Tc-99m methylene diphosphonate (MDP) uptake in the medial cortex of the left femoral diaphysis with matched linear radiolucency on CT images. This was misinterpreted as atypical femoral stress fracture; however, focal stress reaction injury to the nutrient foramen was confirmed on contrast-enhanced magnetic resonance imaging.
Tc-99m MDP Bone scan SPECT SPECT/CT Nutrient foramen
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Compliance with Ethical Standards
Conflict of Interest
This work was supported by the Soonchunhyang University Research Fund. Hwajin Cha, Soo Bin Park, and Hyun-joo Kim declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
The institutional review board of our institute approved this retrospective study, and the requirement to obtain informed consent was waived.
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