Spot images from a whole-body bone scan demonstrate multiple intense adjacent left posterior rib foci grouped in a linear fashion (circle) as well as milder anterolateral rib foci bilaterally (arrows).

Differential Diagnosis

•  Nonaccidental trauma: Multiple focal, adjacent, linearly arranged rib lesions suggest fractures. Multiple fractures of different ages/intensities strongly suggest abuse.

•  Bone metastases: These can commonly appear as multiple rib lesions. However, they are more segmental and more randomly distributed than the ones seen here.

•  Polyostotic osteomyelitis: This can also appear as multiple bone lesions and is more common in children. Again, however, such lesions are not adjacent, as seen here.