Gangrene After Inadvertent Intraarterial Injection of Amphetamine: Appearance on a Three-Phase Tc-99m MDP Bone Scan

Abstract

A 39-year-old man presented to the emergency department with an ischemic left hand after inadvertent injection of amphetamine into the left radial artery 4 days before presentation. Examination revealed a gangrenous left thumb and index finger without clear demarcation and a weak radial pulse. Brachial angiography demonstrated absent blood flow to the digital arteries of the distal left thumb and entire left index finger. A 3-phase Tc-99m MDP (methylene diphosphonate) bone scan was performed 6 days later, which demonstrated nonviability of the distal phalanx of the left thumb and left index finger, distal to the midportion of the proximal phalange. The patient subsequently underwent amputation of the left thumb and index finger at these levels with the bone scan accurately reflecting the operative findings. The 3-phase bone scan was useful in determining the need for and extent of amputation in this case.