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Eumycetoma Osteomyelitis of the Calcaneus in a Child: A Radiologic-Pathologic Correlation following Total Calcanectomy.

El-Sobky TA, Haleem JF, Samir S - Case Rep Pathol (2015)

Bottom Line: Eumycetoma is a chronic cutaneous and subcutaneous infection caused by various genera of fungi.Radiologic-pathologic correlation is an essential supplement for the accurate diagnosis of osteoarticular infections.We conclude that there is a significant agreement between radiologic and pathologic evaluation for assessment of eumycetoma osteomyelitis of the calcaneus.

View Article: PubMed Central - PubMed

Affiliation: Orthopedic Surgery Department, Faculty of Medicine, Ain Shams University, 38 Abbasia Square, Masjed Alnoor, Cairo, Egypt.

ABSTRACT
Fungi are unusual causes of pedal osteomyelitis in children and adolescents. Eumycetoma is a chronic cutaneous and subcutaneous infection caused by various genera of fungi. A provisional diagnosis of foot mycetoma is made after clinical assessment. Radiologic-pathologic correlation is an essential supplement for the accurate diagnosis of osteoarticular infections. This paper aims to sensitize orthopedic surgeons, radiologists, and pathologists to the importance of correlative imaging findings in relation to surgical and microscopic pathology in osteoarticular infections, specifically eumycetoma osteomyelitis of the foot. From our review of the published data, the present case is the first report of radiologic-pathologic correlation in eumycetoma osteomyelitis of the calcaneus. This paper describes a case of eumycetoma osteomyelitis of the calcaneus in a child in which diagnostic X-rays and magnetic resonance imaging (MRI) were correlated with the surgical and microscopic pathologic features, for establishing an appropriate diagnosis and treatment. We conclude that there is a significant agreement between radiologic and pathologic evaluation for assessment of eumycetoma osteomyelitis of the calcaneus. Radiologic-pathologic correlation amplified our interpretation of imaging information available on plain radiographs and MRI and augmented diagnostic confidence. Similarly, anatomic-histopathological correlations consolidated diagnostic accuracy.

No MeSH data available.


Related in: MedlinePlus

(a) Intraoperative images of superior surface of calcaneus employing the heel splitting approach. Note the extensive conglomerates of black grains scattered over that surface (solid arrows). Note the complete destruction of the articular cartilage of the posterior facet of the subtalar joint (hollow arrows). (b) Operative images of superior surface of calcaneus following total resection, employing the heel splitting approach. Note the extensive conglomerates of black grains scattered over that surface (white solid arrows) and the articular cartilage erosions of the anterior and middle facets of the subtalar joint (hollow white arrows). Complete destruction of the articular cartilage of the posterior facet of the subtalar joint with gross deformation is depicted (hollow black arrow). (c) Operative images of inferior surface of the calcaneus following total resection, employing the heel splitting approach. Note the presence of multiple bony cavities of various sizes (white arrows). Foci of black granular discharge are depicted (hollow arrows). (d) Brown fungal colonies with surrounding inflammatory cells and fibrosis (H and E, ×400).
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fig3: (a) Intraoperative images of superior surface of calcaneus employing the heel splitting approach. Note the extensive conglomerates of black grains scattered over that surface (solid arrows). Note the complete destruction of the articular cartilage of the posterior facet of the subtalar joint (hollow arrows). (b) Operative images of superior surface of calcaneus following total resection, employing the heel splitting approach. Note the extensive conglomerates of black grains scattered over that surface (white solid arrows) and the articular cartilage erosions of the anterior and middle facets of the subtalar joint (hollow white arrows). Complete destruction of the articular cartilage of the posterior facet of the subtalar joint with gross deformation is depicted (hollow black arrow). (c) Operative images of inferior surface of the calcaneus following total resection, employing the heel splitting approach. Note the presence of multiple bony cavities of various sizes (white arrows). Foci of black granular discharge are depicted (hollow arrows). (d) Brown fungal colonies with surrounding inflammatory cells and fibrosis (H and E, ×400).

Mentions: In march 2015, we performed total calcanectomy through a heel splitting approach. Under general anesthesia, a high tourniquet was employed in the prone position. Anatomic pathology of the excised calcaneus is depicted in Figures 2(a), 2(b), 3(a), 3(b), and 3(c). The histopathological features were consistent with eumycetoma (Figure 3(d)). The patient was put on oral Itraconazole therapy for 8 weeks. Oral clindamycin therapy was used to treat secondary bacterial infection. Significant clinical improvement was observed at regular followup intervals. The discharging sinuses and the surgical wound demonstrated sound healing.


Eumycetoma Osteomyelitis of the Calcaneus in a Child: A Radiologic-Pathologic Correlation following Total Calcanectomy.

El-Sobky TA, Haleem JF, Samir S - Case Rep Pathol (2015)

(a) Intraoperative images of superior surface of calcaneus employing the heel splitting approach. Note the extensive conglomerates of black grains scattered over that surface (solid arrows). Note the complete destruction of the articular cartilage of the posterior facet of the subtalar joint (hollow arrows). (b) Operative images of superior surface of calcaneus following total resection, employing the heel splitting approach. Note the extensive conglomerates of black grains scattered over that surface (white solid arrows) and the articular cartilage erosions of the anterior and middle facets of the subtalar joint (hollow white arrows). Complete destruction of the articular cartilage of the posterior facet of the subtalar joint with gross deformation is depicted (hollow black arrow). (c) Operative images of inferior surface of the calcaneus following total resection, employing the heel splitting approach. Note the presence of multiple bony cavities of various sizes (white arrows). Foci of black granular discharge are depicted (hollow arrows). (d) Brown fungal colonies with surrounding inflammatory cells and fibrosis (H and E, ×400).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4592886&req=5

fig3: (a) Intraoperative images of superior surface of calcaneus employing the heel splitting approach. Note the extensive conglomerates of black grains scattered over that surface (solid arrows). Note the complete destruction of the articular cartilage of the posterior facet of the subtalar joint (hollow arrows). (b) Operative images of superior surface of calcaneus following total resection, employing the heel splitting approach. Note the extensive conglomerates of black grains scattered over that surface (white solid arrows) and the articular cartilage erosions of the anterior and middle facets of the subtalar joint (hollow white arrows). Complete destruction of the articular cartilage of the posterior facet of the subtalar joint with gross deformation is depicted (hollow black arrow). (c) Operative images of inferior surface of the calcaneus following total resection, employing the heel splitting approach. Note the presence of multiple bony cavities of various sizes (white arrows). Foci of black granular discharge are depicted (hollow arrows). (d) Brown fungal colonies with surrounding inflammatory cells and fibrosis (H and E, ×400).
Mentions: In march 2015, we performed total calcanectomy through a heel splitting approach. Under general anesthesia, a high tourniquet was employed in the prone position. Anatomic pathology of the excised calcaneus is depicted in Figures 2(a), 2(b), 3(a), 3(b), and 3(c). The histopathological features were consistent with eumycetoma (Figure 3(d)). The patient was put on oral Itraconazole therapy for 8 weeks. Oral clindamycin therapy was used to treat secondary bacterial infection. Significant clinical improvement was observed at regular followup intervals. The discharging sinuses and the surgical wound demonstrated sound healing.

Bottom Line: Eumycetoma is a chronic cutaneous and subcutaneous infection caused by various genera of fungi.Radiologic-pathologic correlation is an essential supplement for the accurate diagnosis of osteoarticular infections.We conclude that there is a significant agreement between radiologic and pathologic evaluation for assessment of eumycetoma osteomyelitis of the calcaneus.

View Article: PubMed Central - PubMed

Affiliation: Orthopedic Surgery Department, Faculty of Medicine, Ain Shams University, 38 Abbasia Square, Masjed Alnoor, Cairo, Egypt.

ABSTRACT
Fungi are unusual causes of pedal osteomyelitis in children and adolescents. Eumycetoma is a chronic cutaneous and subcutaneous infection caused by various genera of fungi. A provisional diagnosis of foot mycetoma is made after clinical assessment. Radiologic-pathologic correlation is an essential supplement for the accurate diagnosis of osteoarticular infections. This paper aims to sensitize orthopedic surgeons, radiologists, and pathologists to the importance of correlative imaging findings in relation to surgical and microscopic pathology in osteoarticular infections, specifically eumycetoma osteomyelitis of the foot. From our review of the published data, the present case is the first report of radiologic-pathologic correlation in eumycetoma osteomyelitis of the calcaneus. This paper describes a case of eumycetoma osteomyelitis of the calcaneus in a child in which diagnostic X-rays and magnetic resonance imaging (MRI) were correlated with the surgical and microscopic pathologic features, for establishing an appropriate diagnosis and treatment. We conclude that there is a significant agreement between radiologic and pathologic evaluation for assessment of eumycetoma osteomyelitis of the calcaneus. Radiologic-pathologic correlation amplified our interpretation of imaging information available on plain radiographs and MRI and augmented diagnostic confidence. Similarly, anatomic-histopathological correlations consolidated diagnostic accuracy.

No MeSH data available.


Related in: MedlinePlus