Presentation
Left leg chronic pain and pus discharge.
Patient Data
There is an inflammatory process of the right femoral mid-shaft showing a long intramedullary central linear track extending from the mid to lower femoral shaft, showing marginal post-contrast enhancement and surrounding marrow oedema signal. Diffuse cortical thickening is also noted.
Long sequestrum is seen within the mid-femoral shaft, eliciting a persistent dark signal.
The track ends by breaching the anteromedial and posteromedial cortex at two points (cloaca).
The sinus tract in the posteromedial aspect of the left distal thigh extends posterior to the femur laterally between the anterior and posterior muscle compartments, ending with a cutaneous defect in the posterior-lateral aspect of the left thigh.
No significant abscess formation.
No fracture of the bone is seen.
The rest of the muscles are normal.
A sclerotic bony fragment surrounded by a lucent rim (sequestrum) is seen in the distal femoral diaphysis with an anterior cortical defect (cloaca) and marked thickening of the adjacent cortex (involucrum).
Case Discussion
The features present a typical case of chronic osteomyelitis.
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