Fact-sheet: Osteomyelitis
Updated on 09/17/2021 at 12:16 PM
View all RADEOS cases associated with this fact-sheet
Definition
Infectious involvement of bone:
- by direct inoculation: penetrating wound, open fracture, postoperative
- by contiguity: perforating plantar ulcer, varicose ulcer, soft tissue abscess
- or by hematogenous route: bacteremia, sepsis
Brodie abscess = Metaphyseal form seen in children and young adults (mainly tibia)
Radiography
Acute osteomyelitis:
- disappearance of soft tissue fat planes
- then geographic medullary osteolysis with ill-defined margins
- then endosteal scalloping of the cortex with periosteal reaction
Chronic osteomyelitis:
- bone hypertrophy and osteosclerosis
- lucency containing a sequestrum
Brodie abscess:
- round lucency 1-4 cm surrounded by a rim of osteosclerosis, which may contain a sequestrum or air bubbles (better seen on CT)
Ultrasound
Looks for a subperiosteal abscess or a soft tissue abscess
CT
Acute osteomyelitis:
- Medullary osteolytic lesion with a hypodense abscess, signs of cellulitis
Chronic osteomyelitis
- Look for the sequestrum if not seen on plain radiographs
MRI
Sensitivity and specificity higher than bone scintigraphy.
Marrow edema (hypointense T1, hyperintense T2)
Intraosseous abscess
Enhancement after injection
Associated cellulitis, abscess, soft tissue edema, or tenosynovitis
Vascular intervention
CT- or US-guided aspiration
Nuclear medicine
Early hyperfixation
Differential diagnosis
Osteosarcoma
Ewing sarcoma
Lymphoma