Tc-99m MDP and Ga-67 scintigraphy in gangrenous muscle

A 64-year-old man recently underwent a right above-knee amputation for a gangrenous limb. Although the patient was given broad-spectrum antibiotics, he continued to have high fevers. A bone scan was initially performed to investigate the possible site of infection. An unexpected increase in soft- tissue uptake was seen in the proximal left calf. A striking distal-photon- deficient area was also noted. The results of a subsequent Ga-67 scan showed an increase in soft-tissue uptake in the proximal left calf with a distal area of decreased tracer accumulation. At surgery, the gastrocnemius-soleus complex was found to be gangrenous with a large distal area of nonviable tissue.