Calcaneal osteomyelitis and abscess

Case contributed by Ahmed Abdrabou
Diagnosis certain


Opening into the foot discharging pus. History of previously penetrating injury to a barefoot 1 month ago

Patient Data

Age: 21 years old
Gender: Male

Extensive marrow edema of the calcaneous displaying low T1 and high T2/STIR signal intensity. There is also cortical destruction of its medial aspect and an adjacent large irregular shape ill defined area of fluid collection that open into the skin by wide sinus track. It displays avid peripheral enhancement on post contrast study suggesting abscess. Nevertheless there is focal area of enhancement at the posteromedial aspect of the calcaneous.

Case Discussion

Penetrating injury to a barefoot can result in osteomyelitis of the tarsal/metatarsal bones and abscess formation. MR signs of acute osteomyelitis include extensive marrow edema, cortical destruction and abnormal enhancement together with peripheral enhancing or gas containing abscess. Diabetes mellitus can be a risk factor but no present in the current case. The patient underwent surgical debridement which revealed mixed organisms predominantly Staph.aureus

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