INTRAMEDULLARY FAT NECROSIS OF MULTIPLE BONES ASSOCIATED WITH PANCREATITIS

We describe findings of intramedullary fat necrosis on five imaging st udies in a patient with alcoholic pancreatitis. Radiography and CT of extremities showed multiple osteolytic lesions that were initially con sidered to be metastases, However, a Tc-99m-methylene diphosphonate wh ole-body bone scan revealed abnormal areas of increased uptake in only the bones of extremities without involvement of the axial skeleton, a distribution quite unusual for metastatic disease. Furthermore, Tc-99 m-sestamibi scintigraphy was essentially normal. MRI revealed findings compatible with the diagnosis of fat necrosis/infarct, Findings from bone biopsy demonstrated necrotic bone marrow without malignant cells. It may not be necessary to perform all the imaging studies described in this report when clinical features suggesting metastatic fat necros is are present. Appearance and distribution of abnormalities on the wh ole-body bone scan and MR images show that necrosis/infarct of the mar row may obviate bone biopsy, which is often needed to confirm the diag nosis of intramedullary fat necrosis and to exclude neoplastic process es.