Presentation
Anterior lower left leg pain of several months duration, no past history of trauma or operations
Patient Data
There is an oval shaped well defined intra-medullary lytic lesion involving meta-diaphyseal region of lower tibia. It is seen surrounded by an irregular sclerosis. No cortical breaching and no periosteal reaction.
An irregular yet well defined intra-medullary non-expanding lesion of abnormal signal intensity is seen involving the meta-diaphysis of the lower tibia. It has a small projection heading towards the growth plate (arrows).
The lesion shows the classic penumbra sign.
Case Discussion
Finger-like extension from the abscess directing towards the epiphyseal plate is said to be pathognomonic and indicates infection tunneling 1 and this communication with the epiphysis is one of the what-does-the-clinician-want-to-know signs 2