"Cold" and "hot" osteomyelitis on bone scintigraphy

Bone scanning is frequently used for the assessment of a child with pain around the hip joint. The authors present a child with septic hip arthritis in which a striking abnormality of complete absence of tracer uptake in an extensive region of the proximal femur was demonstrated on bone scintigraphy. Later during the course of his disease, markedly increased tracer uptake was seen along most of the femoral diaphysis with the exception of the avascular proximal bone. These scintigraphic findings represent extensive osteomyelitis of the femur with avascular necrosis of its proximal part.