Intraosseous Medullary Fat Necrosis on 99mTc-MDP Bone Scan of Patient With Acute Pancreatitis

Pancreatic disease can be associated with polyarthritis and panniculitis in a small number of patients, and this triad constitutes PPP syndrome. Early diagnosis is critical as it has high morbidity and mortality. Panniculitis can occur in fat present anywhere in the body. Involvement of fat in bone marrow is relatively uncommon, and radiologic imaging shows osteolytic lesions involving long bones. Here we present a case of acute pancreatitis, referred to our department for evaluation of severe joint pain and multiple bone pain. Tc-99m-MDP scan with SPECT/CT has been done, which showed medullary expansion with heterogenous tracer uptake, that is, moth-eaten appearance.