Osteomyelitis (Greater Than 18 Months)

  • Etiology: most commonly Staphylococcus aureus, salmonella in sickle cell disease, can be spread hematogenously or by direct extension from skin wound
  • Imaging: primary site is metaphysis + does not involve epiphysis, continuous periosteal reaction, deep soft tissue edema, lack of extra osseous soft tissue mass
  • Complications: subperiosteal abscess, intramedullary abscess, sequestrum (dead bone) resides inside involucrum (periosteal new bone) + debris + pus drains through the cloaca to a fistula / sinus tract to soft tissue + skin
  • Clinical: multicentric in 10%

Cases of Osteomyelitis (Greater Than 18 Months)

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.
Radiograph and nuclear medicine bone scan of osteomyelitis of the femur
AP radiograph of the pelvis was unremarkable. Nuclear medicine bone scan shows increased radiotracer uptake in the left femoral head and neck and proximal femur.
CT and MRI of osteomyelitis of the rib
Axial CT without contrast of the chest (above) shows bilateral axillary adenopathy and soft tissue swelling over the left lateral chest wall and associated rib destruction. Coronal T2 MRI of the chest (below left) shows a high signal intensity fluid collection between the skin and the ribs with surrounding edema. Axial T1 MRI with contrast of the chest (below right) shows extensive enhancement of the left ribs and surrounding muscle.