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Figure 2. A 73-year-old female with severe low back and left leg pain referred with suspected sacral and pelvic metastases. (a) Plain radiograph at presentation shows no significant abnormality, although a follow-up film 4 weeks later (b) shows sclerosis in the right sacral ala (arrows). (c) Posterior view of isotope bone scan shows marked abnormal uptake at right side of sacrum (arrow). (d) CT confirms unilateral sacral fracture (arrow). (e) Posterior view of isotope bone scan 8 months later showing avid uptake in the right side of sacrum and right ilium (arrow) and uptake in the left side of sacrum (arrowhead). (f) CT scan at this time showing right iliac fracture (arrow) and sclerosis due to healing of the right sacral insufficiency fracture (arrowhead), with less marked sclerosis at the left sacral ala from healing of left side insufficiency fracture.
