Scintigraphic Diagnosis of Costal Periostitis in Actinomycosis

A 25-year-old man with a history of occasional intravenous drug abuse was admitted to the hospital complaining of left-sided pleural discomfort and a chest wall mass, draining smelly pus, of 6 monthsʼ duration. Culture of the pus showed Actinomyces israelii. To detect a possible osseous involvement of the infectious process and to differentiate between periostitis and osteomyelitis of the neighboring ribs, Tc-99m MDP bone scintigraphy was performed.