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Hot Calcaneus on Three Phase Scintigraphy Due to Bone Bruise

Gabriel Soudry, MD
J Stevan Nagel, MD

June 16, 1994

Presentation

A 35-year-old nurse, with no significant medical history and no recollection of foot trauma, was experiencing persistent left heel pain worsened by walking.

Imaging Findings

Plain Radiograph
Bone Scintigraphy
Magnetic Resonance Imaging

A plain radiograph of the ankle and foot showed no abnormality of the cortical bone.

Six months later, a three phase radionuclide bone scan showed markedly increased uptake in all 3 phases in the region of the left calcaneus. Note the increased flow (arrow), blood pool (arrows), and delayed activity (arrows) in this region.

MRI (oriented to match radiograph) shows abnormal bright signal intensities in the anterior portion of the calcaneus on T2-weighted images (arrow).

Diagnosis

A bone bruise involving the anterior aspect of the calcaneus.

Discussion

Bone bruises were first described in association with major knee injuries (collateral ligament or anterior cruciate ligament disruptions) and result from compressive forces incurred during the injury. The lesion is by definition confined to the medullary bone. The cortical bone and articular cartilage remain intact. The suspected basic pathology is trabecular disruption with edema and hemorrhage. Bone scan shows increased tracer localization in the lesion. On MR imaging, bruises appear as areas of decreased signal on T1-weighted imaging and increased signal on T2-weighted imaging. Bruises are considered to be self-limiting and essentially benign abnormalities.

References

1. Yao L, Lee JK. Occult intraosseous fracture: Detection with MR imaging. Radiology 1988;167(3):749-751.

2. Deutsch AL, Mink JH. Magnetic resonance imaging of musculoskeletal injuries. Radiol Clin N Am 1989;27(5):983-1002.

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