Presentation
Bilateral knee pain. New intense exercise regiment.
Patient Data
Frontal and lateral views of both knees are normal.
A small metallic BB on each radiograph annotates the site of pain.
Lower body bone scan performed 3 hours after administration of 20 mCi Tc99m MDP IV.
There is abnormal intense radiotracer uptake in the medial aspect of both proximal tibial metaphases.
Coronal PD fat sat images of both knees show transverse fracture lines involving the medial aspect of both tibial metaphases surrounded by marrow edema, confirming bilateral stress fractures.
Case Discussion
Bone scintigraphy is much more sensitive than radiographs for the diagnoses of stress fractures with greater than 80% of stress fractures being occult on initial x-rays (as in this case).
On bone scintigraphy, focal increased uptake, in the appropriate clinical context, is consistent with a bone stress fracture.
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