Woman with persistent low back and pelvic pain. Bone scan 99mTc-MDP.

Case presentation:

• Female.
• 67 y.o.
• Presentsto tothe thehospital hospital with with persistent persistentlow lowback back and andpelvic pelvicpain pain.
• History Historyof ofcolon colon cancer cancerwith withsurgical surgicaland andradiation radiation treatment treatment5 5 years yearsbefore before.
• No other othersymptoms symptoms, no , no weight weightloss loss.
• Physical examination reveals good general condition.
• Plain X-ray shows moderate spondylosis, no other remarks.
• Laboratory tests within normal limits.

Teaching points:

• Spontaneus fractures (usually secondary to minimal trauma) are not rare in posmenospausal women due to loss of bone mineral matrix.
• Radiotherapy can also produce alteration of bone matrix.
• The bone scan pattern is tipycal and should not be confused with bone metastases.
• Sacrum fractures usually adopt the characteristic "H" pattern.
• Other lesions of the iliopubic and ischiopubic branches as well as vertebral and rib fractures are frequent.