Utility of bone scintigraphy in diagnosis of post- traumatic osteitis pubis
A 58-year-old, post-menopausal, nulliparous woman, presented with severe pain in anterior lower part of abdomen and left hip region, since 2 months, pain was insidious in onset and started, soon after a minor stretch injury to pelvis while getting down from a bus. There was no history of acute or chronic illness, fever, abdominal surgery, endoscopic procedure, or arthritic disease. Clinical examination revealed localized pain in inguinal, suprapubic and left hip region, aggravating with walking. Her insidious onset of pain at these sites raised high suspicion of soft tissue, ligament or avulsion injury in pelvis. She was evaluated with routine hematological investigations and X-ray pelvis, they were normal and ruled out bone fracture or a lesion in symphysis pubis causing pain. To evaluate further, she was referred for technetium-99m methylene diphosphonate bone scintigraphy. Her bone scintigraphy, anterior and posterior planar image of pelvis revealed intense radiotracer uptake in symphysis pubis region. In addition to this, area of mild diffuse increase tracer uptake with focal intense lesion was localized in lower part of left sacroiliac (SI) joint []. She was also evaluated with bone single photon emission computerized tomography (SPECT) of pelvis. SPECT, reconstructed transverse and coronal images showed intense uptake in symphysis pubis, mild diffuse increased tracer uptake with focal intense lesion in left SI joint, lower part []. Both planar and SPECT findings were correlated with the site of trauma and suggestive of reactive and reparative changes in symphysis pubis and left SI joint. We also correlated these findings with CT scan using software based fusion of SPECT and CT images which showed no structural abnormality in symphysis pubis and documented early sclerotic changes in lower part of left SI joint, suggestive of post-trauma, arthritic changes []. Patient was reassured and managed conservatively with bed rest and non-steroidal anti-inflammatory drugs, which relieved her symptoms.