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Chronic osteomyelitis: clarification of nuclear medicine findings by fusion scans.

A 61-year-old man had a soft tissue infection in the left popliteal region 33 years after a gunshot wound produced a compound comminuted fracture of the left distal femur. An In-111 leukocyte scan at 24 hours (obtained with a concurrent Tc-99m MDP dual-isotope scan) was trace positive. A subsequent Ga-67 scan at 48 hours (also obtained with a dual-isotope Tc-99m MDP scan) was strongly positive. Dual-isotope SPECT of the Ga-67 and Tc-99m MDP scan was used for postacquisition fusion imaging with a computed tomograph (CT) of the legs. A preoperative diagnosis was made of soft tissue infection seeded from an adjacent sequestered infection in the fracture site. At surgery, an abscess in the soft tissues was connected by a fistulous track to a necrotic, infected focus in a cortical crevasse. Cultures were positive for Proteus mirabilis.