Chronic osteomyelitis

Case contributed by Subhan Iqbal
Diagnosis probable

Presentation

Fever, leg pain, warmth on and off

Patient Data

Age: 10 years
Gender: Male
x-ray

Significantly displaced pathological fracture identified at midshaft of femur, overlapping of bone ends and callus formation is noted. Lamellated periosteal reaction noted along the mid distal shaft of femur anterolaterally. Multiple patchy lucencies are seen within the medullary canal of femur predominantly in mid lower aspect. All described imaging findings are secondary to chronic osteomyelitis.

Case Discussion

The earliest changes are seen in adjacent soft tissues +/- muscle outlines with swelling and loss or blurring of normal fat planes. An effusion may be seen in an adjacent joint.

In general, osteomyelitis must extend at least 1 cm and compromise 30 to 50% of bone mineral content to produce noticeable changes on plain radiographs. Early findings may be subtle, and changes may not be obvious until 5 to 7 days from onset in children and 10 to 14 days in adults.

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