Pediatric Chronic Recurrent Multifocal Osteomyelitis

  • Etiology: Idiopathic episodic auto-inflammatory disorder with nonbacterial multifocal osteomyelitis
  • Imaging:
    — Usually asymmetric and metachronous, no significant fluid
    — Most common locations: Metaphyses of long bones, medial clavicles, vertebral bodies, mandible, pelvis, ribs
  • Imaging Radiograph: Variable morphologies or densities – bubbly lucent, aggressive lytic, sclerotic
  • Imaging MRI: Whole body STIR MRI used to monitor disease course
  • DDX:
  • Complications:
  • Treatment:
  • Clinical:
    — Primarily in children and adolescents
    — Most common disease to affect medial 1/3 of clavicle

Radiology Cases of Chronic Recurrent Multifocal Osteomyelitis

Whole body STIR MRI of chronic recurrent multifocal osteomyelitis
Coronal STIR MRI of the chest (above) shows increased bone marrow signal in the bilateral clavicular heads. Coronal STIR MRI of the knees (below left) and ankles (below right) shows increased bone marrow signal intensity in the bilateral distal femoral metaphyses, left distal femoral epiphysis, bilateral proximal tibial metaphyses and bilateral distal tibial metaphyses.
Radiograph and CT of chronic recurrent multifocal osteomyelitis (CRMO)
AP and lateral radiographs of the spine (2 left-most images) show hyperostosis of the medial aspect of the bilateral clavicles and flattening (vertebra plana) of the T4, T7 and T8 vertebral bodies. Coronal and sagittal 2D reconstructions from a CT without contrast of the spine (2 right-most images) show in more detail the vertebra plana of the T4, T7 and T8 vertebral bodies.