Chronic osteomyelitis - tibia (with sequestrum)

Case contributed by Dr Utkarsh Kabra

Presentation

Pain in left leg, previous DVT.

Patient Data

Age: 75 years
Gender: Male

Well defined intramedullary altered signal intensity lesions measuring approx. 12 x 17 x 79 mm in proximal shaft of left tibia. 

Similar lesion measuring approx. 6.7 x 7.3 x 50 mm is seen in distal shaft of left tibia 

No evidence of soft tissue component seen. No obvious cortical breach or significant surrounding marrow edema is seen .

Visualized muscles of left leg shows significant reduced bulk with moderate fatty atrophy and hyperintensity. 

 

Corresponding CT cuts show a well defined lesion in proximal shaft of left tibia with a lucent rim and central dense calcification. 

Case Discussion

  • Well defined intramedullary altered signal intensity lesions in proximal and distal shafts of left tibia. Corresponding CT cuts show well defined lesions in proximal and distal shafts of femur with a lucent rim and central dense calcification consistent with chronic osteomyelitis with sequestrum.  
  • Reduced bulk with moderate fatty atrophy and hyperintensity of visualized muscles of left leg, possibly related to denervation changes/chronic compartment syndrome. 

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