Back to Osteomyelitis 5

Osteomyelitis - MR

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Case Notes

History

Persistent right shin pain with aggressive lesion identified on prior radiograph. Positive for leukocytosis and fever. Elevated erythrocyte sedimentation rate/C-reactive protein.

Exam

Prior Study

Dicom

 

Findings

You scored: 0 / 21
Limitations Correct Answer Your Answer

There is patient motion or other limitations.

 No  NA
Skin/Hypodermis Correct Answer Your Answer

There is edema or hyperenhancement.

 Yes  NA

There is soft tissue ulceration or sinus tract.

No  NA

There is gas or foreign body.

 No  NA

There is confluent hypoenhancement to suggest phlegmon, suppuration, abscess, or drainable fluid collection in the hypodermis.

 No  NA
Investing/Intermuscular Fascia Correct Answer Your Answer

There is edema, thickening, or hyperenhancement.

No  NA

There is hypoenhancement or gas/susceptibility artifact.

 No  NA

There is bulging of the fascia.

 No  NA
Muscles Correct Answer Your Answer

There is edema or hyperenhancement.

Yes  NA

There is hypoenhancement, lack of enhancement, or organized fluid collection.

No  NA

There is fatty atrophy.

 No  NA
Bones Correct Answer Your Answer

There are fractures.

 No  NA

There is periosteal reaction, osseous destruction, or other abnormal marrow to suggest osteomyelitis.

 Yes  NA

There is osseous hypoenhancement or lack of enhancement to suggest loss of bone viability.

 Yes  NA

There is cloaca, sequestrum, or involucrum.

 Yes  NA

There is a subperiosteal or intra-osseous abscess.

 Yes  NA
Visualized Joints Correct Answer Your Answer

There is a joint effusion or synovitis.

 No  NA

There is malalignment, degenerative changes, or other gross internal derangement.

 Yes  NA
Miscellaneous Correct Answer Your Answer

There is tenosynovitis.

 No  NA

Major visualized vascular structures are abnormal.

 No  NA

Major visualized nerves are abnormal.

 No  NA

Impression

Expert Answer

Large intraosseous abscess with surrounding osteomyelitis in the mid to distal tibia. Sequestrum better demonstrated on prior CT. Multiple cloacae are present with inflammatory material extending into the subperiosteal space.

Your Answer

Recommendations & Acuity

Recommendations

Expert Answer

Orthopedic consultation.

Your Answer

Acuity

Expert Answer

Urgent (Action Necessary in a few hours)

Your Answer

View Reference Material
Section 1

Submit Findings

CB1141

Findings

Limitations

There is patient motion or other limitations.

Skin/Hypodermis

There is edema or hyperenhancement.

There is soft tissue ulceration or sinus tract.

There is gas or foreign body.

There is confluent hypoenhancement to suggest phlegmon, suppuration, abscess, or drainable fluid collection in the hypodermis.

Investing/Intermuscular Fascia

There is edema, thickening, or hyperenhancement.

There is hypoenhancement or gas/susceptibility artifact.

There is bulging of the fascia.

Muscles

There is edema or hyperenhancement.

There is hypoenhancement, lack of enhancement, or organized fluid collection.

There is fatty atrophy.

Bones

There are fractures.

There is periosteal reaction, osseous destruction, or other abnormal marrow to suggest osteomyelitis.

There is osseous hypoenhancement or lack of enhancement to suggest loss of bone viability.

There is cloaca, sequestrum, or involucrum.

There is a subperiosteal or intra-osseous abscess.

Visualized Joints

There is a joint effusion or synovitis.

There is malalignment, degenerative changes, or other gross internal derangement.

Miscellaneous

There is tenosynovitis.

Major visualized vascular structures are abnormal.

Major visualized nerves are abnormal.