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Acute on chronic osteomyelitis Post-traumatic changes with deformity after trauma

Patterson RAP - MedPix (2005)

View Article: MedPix Image - MedPix Case

Affiliation: Uniformed Services University

ABSTRACT

Diagnosis: Acute on chronic osteomyelitis Post-traumatic changes with deformity after trauma

History: 82 y/o female with significant left knee pain for four days; the patient is asplenic and has a prior history of osteomyelitis in the same knee.

Findings: 1) Anteroposterior radiograph of the left knee demonstrates areas of osteolysis in the distal metaphysis of the femur. 2) Lateral radiograph of the left knee demonstrates extensive cortical thickening with foci of osteolysis in the visualized distal femur and some deformity of the femur most marked in the distal metadiaphysis and the medial femoral condyle 3) 3-phase methylene diphosphonate (MDP) 99-m bone scintigraphy demonstrates increased radiopharmaceutical uptake in the distal left femur. The 20-hour delayed fused images (99m Tc-MDP with 111-In-WBC) showed concordant dual tracer accumulation in the distal left femur consistent with osteomyelitis. 4) Axial CT of the left knee with bone windows demonstrates sclerotic medullary and cortical changes of the left mid and distal femur with cortical lucencies and acute nonfatty medullary inflammatory changes. An osseous sequestrum is present in the distal posterior femur. At the level of the condyles, the medullary canal communicates through a cortical defect into the soft tissues.

Ddx: Acute on chronic osteomyelitis Post-traumatic changes with deformity after trauma

Exam: The patient had significant pain to palpation of the left knee and on weightbearing. She had an elevated WBC with a left shift and eleveated ESR and C-reactive protein. A joint aspirate of the left knee revealed polymorphonucleated and mononucleated white blood cells.

No MeSH data available.


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Acute on chronic osteomyelitis Post-traumatic changes with deformity after trauma

Patterson RAP - MedPix (2005)

© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=MPX2448&req=5

View Article: MedPix Image - MedPix Case

Affiliation: Uniformed Services University

ABSTRACT

Diagnosis: Acute on chronic osteomyelitis Post-traumatic changes with deformity after trauma

History: 82 y/o female with significant left knee pain for four days; the patient is asplenic and has a prior history of osteomyelitis in the same knee.

Findings: 1) Anteroposterior radiograph of the left knee demonstrates areas of osteolysis in the distal metaphysis of the femur. 2) Lateral radiograph of the left knee demonstrates extensive cortical thickening with foci of osteolysis in the visualized distal femur and some deformity of the femur most marked in the distal metadiaphysis and the medial femoral condyle 3) 3-phase methylene diphosphonate (MDP) 99-m bone scintigraphy demonstrates increased radiopharmaceutical uptake in the distal left femur. The 20-hour delayed fused images (99m Tc-MDP with 111-In-WBC) showed concordant dual tracer accumulation in the distal left femur consistent with osteomyelitis. 4) Axial CT of the left knee with bone windows demonstrates sclerotic medullary and cortical changes of the left mid and distal femur with cortical lucencies and acute nonfatty medullary inflammatory changes. An osseous sequestrum is present in the distal posterior femur. At the level of the condyles, the medullary canal communicates through a cortical defect into the soft tissues.

Ddx: Acute on chronic osteomyelitis Post-traumatic changes with deformity after trauma

Exam: The patient had significant pain to palpation of the left knee and on weightbearing. She had an elevated WBC with a left shift and eleveated ESR and C-reactive protein. A joint aspirate of the left knee revealed polymorphonucleated and mononucleated white blood cells.

No MeSH data available.