Bifocal osteomyelitis - ankle

Case contributed by Dr Ammar Haouimi

Presentation

Painful left ankle with fever, leukocytosis and elevated ESR and CRP.

Patient Data

Age: 17 years
Gender: Male
x_ray

Enlarged growth plate of the distal fibula with ill-defined focal osteopenia of the medial aspect of the tibial metaphysis and adjacent epiphysis.

mri

There are two ill-defined lesions involving the tibial and fibular growth plate, extending to the adjacent epiphysis and metaphysis through a cortical interruption with perifibular periosteal reaction. They elicit an iso-to low signal to the bone marrow on T1, high signal on T2 fat sat with moderate heterogeneous enhancement on postcontrast sequences. Adjacent tibial and fibular bone marrow edema is noted as well as soft tissue edema mainly of the lateral aspect of the ankle.

Case Discussion

CT features most consistent with bifocal osteomyelitis of the distal tibia and fibula.

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