Tc-99m MDP Bone Scintigraphy in Septic Shock

An 8-year-old girl presented with a history of diarrhea, vomiting, and drowsiness. Clinical examination confirmed septic shock with marked metabolic acidosis. As a complication of septicemia, severe ischemia of all 4 limbs was noted from day I and she subsequently developed peripheral gangrene. Tc-99m MDP bone scan showed extensive bone infarction in all 4 limbs. Early diagnosis of osteonecrosis and amputation may prevent worsening of sepsis. However, it is not possible to clinically demarcate the level of amputation. Bone scan is a useful diagnostic tool in determining the appropriate level of amputation.