COMMON BONE

INFECTIONS

DR. SAMUEL INBARAJA SUNDAR

 SEPTIC ARTHRITIS
●
RADIOLOGICAL FEATURES: EARLY INFECTION:PLAIN RADIOGRAPH –
NO FEATURES DETECTABLE
● USG : BEST FOR DETECTING OR EXCLUDING JOINT FLUID
● US FINDINGS -NON SPECIFIC – CANNOT DIFFRENTIATE BETWEEN FLUID,
PUS, BLOOD ETC .SYNOVIAL THICKENING – NON SPECIFIC
● RELAIBLE METHOD : ASPIRATION WITH USG GUIDANCE AND LAB
ASSESSMENT
● INTERMEDIATE INFECTION: PLAIN FILM : OSTEOPENIA AROUND THE
JOINT
● CT – EFFUSION AND LOSS OF MINERAL
● MR – OEDEMA IN ADJACENT MARROW, EFFUSION AND SYNOVITIS
● EARLY CORTICAL THINING EVIDENT ON ALL IMAGING AND EARLY
CORTICAL DESTRUCTION IS SEEN IN ADJACENT BONES
●
LATE INFECTION: PLAIN FILM : MARGINAL DESTRUCTION AND BONE
EROSION
● CT : MARGINAL DESTRUCTION AND BONE EROSION MORE STRIKING
● MR: DEFINES EXTENT OF BONE AND SOFT TISSUE INVOLVEMENT
● BONE CHANGES FINALLY RESEMBLE OSTEOMYELITIS AS SEEN
ELSEWHERE
 ACUTE OSTEOMYELITIS
● CAUSE : STAPHYLOCOCCUS AUREUS
● C/F – RECURRENT FEVER , BONE PAIN , FRACTURES
●
RADIOLOGICAL FEATURES:
● PLAIN RADIOGRAPHIC FINDINGS: SOFT TISSUE SWELLING ,
PERIOSTEAL REACTION,CORTICAL
IRREGULARITIES,DEMINERALIZATION
● CT FINDINGS: VALUE IN STUDYING ARTICULAR SURFACE
AND PERIARTICULAR SOFT TISSUE
● FOR DELINEATING THE EXTENT OF MEDULLARY AND SOFT
TISSUE INVOLVEMENT
● SAME FEATURES AS SEEN IN XRAYS
● DEPICTS CHANGES EARLIER THAN CONVENTIONAL
RADIOLOGY
 nd
2 metatarsal head osteomyelitis
 CHRONIC OSTEOMYELITIS
● CAUSE: MYCOBACTERIUM TUBERCULOSIS ,SYPHILIS
● RADIOGRAPHIC FINDING : XRAYS:THICK IRREGULAR
SCLEROTIC BONE INTERSPERSED WITH IRREGULAR
LUCENCIES,ELEVATED PERIOSTEUM AND DRAINING SINUSES
● CT : SAME FEATURES DETECTED MUCH EARLIER
● CT SHOWS MORE SEQUESTRA AND INVALUABLE IN THE
SEARCH FOR SEQUESTRA.THEY APPEAR AS LOW
ATTENUATION AREAS
● INVOLUCRUM – THE NEW BONE APPEARS AS HOMOGENOUS
WHITE DENSITIES – HIGH ATTENUATION AREAS
● MRI : T1W IMAGE – DECREASED SIGNAL INTENSITY
● T2W IMAGE – INCREASED SIGNAL INTENSITY
● STIR IMAGES – INCREASED SIGNAL INTENSITY
● FEATURES BECAUSE OF REPLACEMENT OF FAT IN MARROW
WITH EDEMA , FLUID .
Chronic osteomyelitis knee
 MRI OF
SEQUESTRUM :
CORTICAL BONE – HYPOINTENSE SIGNAL IN
T1W,T2W AND STIR IMAGES AND NO GADOLINIUM
ENHANCEMENT
CANCELLOUS BONE – HYPERINTENSE SIGNAL IN
T1W, T2W AND STIR IMAGES AND NO GADOLINIUM
ENHANCEMENT

INVOLUCRUM
HYPOINTENSE IN T1W,T2W AND STIR IMAGES AND
ENHACES WITH GADOLINIUM CONTRAST

DRAINING SINUSES AND SOFT TISSUE

INFLAMMATION ARE HYPOINTENSE ON T1W ,
HYPERINTENSE ON T2W AND STIR AND SHOW S
ENHANCEMENT WITH GADOLINIUM CONTRAST
SEQUESTRUM
 USG FINDINGS IN CHRONIC OSTEOMYELITIS:

● PERIOSTEAL REACTION AND SOFT TISSUE

SWELLING
● NUCLEAR MEDICINE SCAN :
● TECHNITIUM 99 DIPHOSPHONATE SCAN
● ACUTE INFECTION – INCREASED UPTAKE AT
FOCAL SITES OF INFECTION
● CHRONIC INFECTION – INCREASED UPTAKE
UPTO 2 YEARS AFTER SUCCESSFUL
THERAPY
 SCLEROSING OSTEOMYELITIS
OF GARRE
● SPECIAL TYPE OF OSTEOMYELITIS WHICH IS
CHARACTERISED BY HIGH DEGREE OF
SCLEROSIS AND EXPANSION OF THE BONE .
● IT IS NON PURULENT
● THE SCLEROSIS IS BECAUSE OF
PERIOSTEAL REACTION
● MOST COMMONLY AFFECTS THE MANDIBLE
GARRE OSTEOMYELITIS TIBIA
 BRODIE'S ABSCESS
●
MOST COMMON TYPE OF SUB-ACUTE FORM OF OSTEOMYELITIS
●
CHARACTERISTICS OF ACUTE INFECTION ARE ABSENT
●
INSIDIOUS ONSET ,MILD SYMPTOMS , LACK OF SYSTEMIC
REACTION
●
MIMICS VARIOUS BENIGN AND MALIGNANT CONDITIONS
●
IT IS A LOW GRADE PYOGENIC ABSCESS OF THE BONE
● RADIOLOGICAL FEATURE :
●
XRAY PLAIN FILM - SOLITARY LESION WITH SURROUNDING
SCLEROSIS SEEN IN METAPHYSIS , DIAPHYSIS AND CROSSING
EPIPHYSESAL PLATE INTO EPIPHYSES
●
CT SCAN – DIFFERENTIATE BETWEEN SUB ACUTE
OSTEOMYELITIS AND OSTEOID OSTEOMA
● MRI – T1W LOW SIGNAL INTENSITY , T2W HIGH SIGNAL INTENSITY
WITH LOW SIGNAL RIM OF SCLEROSIS
BRODIE ABSCESS