Distortion of dual energy X-ray images by faecal masses in a child with type 1 diabetes

Dual energy X-ray absorptiometry (DXA) scanning is the most common investigating modality used to assess bone mineral density (BMD). Conditions causing tissue calcification and artefacts such as metallic objects may mislead the results of the DXA scan. We present here a case of a child with diabetes where the DXA images were distorted by faecal lumps, leading to falsely elevated BMD and an error in interpretation of the DXA scans. Our case suggests that DXA software may not, at times, differentiate between bone and other high-attenuating material within the regions of interest. Thus, DXA images should also be visually examined and verified with the numeric data before report preparation in these patients.