Bone Scintigraphy for the Evaluation of Possible Osteomyelitis in the Lower Extremity Leads to the Detection of a Brain Abscess

A 17-month-old boy presented with fever and lethargy for 2 days. A complete physical examination rendered no results to explain the source of the fever. Laboratory tests only showed leukocytosis, whereas CT scans of the chest, abdomen, and pelvis were unrevealing. Because the patient refused to walk, possible osteomyelitis of the lower extremities was suspected by referring physicians, and 3-phase bone scintigraphy of the lower extremities was acquired to confirm the suspicion. The bone-scan images showed no abnormal activity in the lower extremities. However, there was increased activity in the region of the mastoid of the right temporal bone. This finding prompted subsequent head CT scan that showed opacification of the middle ear cavity and mastoid air cells with destruction of mastoid bone, suggestive of otomastoiditis and possible osteomyelitis as a complication. In addition, CT showed a large right cerebellar abscess.