Chronic osteomyelitis in a beta thalassemia major patient
Background of beta Thalasemia major. Increasing right hip and knee pain, 4 months following anterior thigh infected haematoma requiring washout. Not on antibiotics at time of current presentation.
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Nuclear medicine (bone scan) - Note the evolution of osteomyelitis in a 4 month period. Image 1 - acute osteomyeltis, decreased uptake due to tamponade effect from mass effect. Image 2 - increased uptake due to increased osteoblast activity in the local region (chornic stage - no mass effect as necrosis of most both cortex and medulla and cloaca present).
CR - Background osteoporosis due to underlying condition of beta thalassaemia major. Degenerative changes in the right hip - thalassaemia related arthropathy. Severe periosteal reaction along the femoral diaphysis. Well defined lucencies in the proximal and distal femur, not present on previous xrays suggest abscess formation. Destruction of the lateral aspect of the distal femoral diaphysis (cloaca noted). Underlying soft tissue involvement should be considered.
Significant periosteal reaction, cortical destruction and lucent areas in the medullary bone. Findings consistent with osteomyelitis +/- bony abscesses (Brodie's) that is draining.
Increasing right hip and thigh pain 3 months following surgical washout of large infected thigh haematoma.
MRI confirmed dx. No soft tissue involvment.