Cold osteomyelitis. Radionuclide bone scan findings.

Absence of Tc-99m MDP accumulation in bone may be due to various causes, including infection, infarction, neoplasm, foreign bodies, or artefacts (1,2). In our patient, absence of radionuclide was noted in the proximal metaphyseal region of his left tibia, along with increased activity distally. These findings were attributed to a "cold" osteomyelitis caused by pus beneath the periosteum. Initial x-rays were interpreted as normal, while subsequent films demonstrated gross abnormalities. Few cases of cold osteomyelitis have been reported.