Pediatric Chronic Osteomyelitis

  • Etiology: low grade continuous infection
  • Imaging: bone sclerosis
  • DDX:
  • Complications: sequestrum (necrotic bone fragment) resides inside involucrum (thick periosteal new bone) + debris + pus drains through the cloaca (draining tract through defect in cortex and involucrum) to soft tissue + skin
  • Treatment:
  • Clinical: infection may be quiescent for long period of time and resume at any time

Cases of Chronic Osteomyelitis

Radiograph of osteomyelitis with Brodie's abscess
AP radiograph of the knee at presentation (upper left) shows lucent lesions of the metaphysis and epiphysis which show some interval healing on a followup AP radiograph of the knee taken 2 months later (upper right). The patient was lost to followup and did not complete antibiotic therapy and returned to clinic 2 years later and the AP radiograph at that time (lower left) shows a lucent sinus tract extending from the epiphysis to the metaphysis that persists on the next AP radiograph of the knee obtained 1 year later (lower right).
Radiograph of chronic osteomyelitis of the femur
AP radiograph of the proximal left femur shows a lucent lesion containing multiple septations that is associated with extensive cortical thickening and periosteal reaction. Percutaneous bone biopsy was performed.