Chronic osteomyelitis in a beta thalassemia major patient

Case contributed by Townsville radiology training


Background of beta Thalasemia major. Increasing right hip and knee pain, 4 months following anterior thigh infected hematoma requiring washout. Not on antibiotics at time of current presentation.

Patient Data

Age: 30 years
Gender: Male

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 thalassemia major. Degenerative changes in the right hip - thalassemia 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.

Case Discussion

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 hematoma.

MRI confirmed dx. No soft tissue involvment.

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