Chronic osteomyelitis (with sequestrum)

Case contributed by Michael P. Hartung
Diagnosis certain

Presentation

Chronic draining wound with inability to walk.

Patient Data

Age: 40 years
Gender: Male
This study is a stack
Axial
non-contrast
This study is a stack
Coronal
non-contrast
This study is a stack
Sagittal
non-contrast
This study is a stack
Axial
non-contrast
This study is a stack
Coronal
non-contrast
This study is a stack
Sagittal
non-contrast
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Info

Left femoral enlargement, sclerosis, and irregularity. Displaced and mildly comminuted fracture of the proximal 1/3 of the diaphysis along the upper margin of the cortical irregularity. 

Small tubular fragment within the distal femoral diaphysis deep to a defect in the posterior cortex, and connecting to a sinus tract extending into the lateral thigh. 

Anterior compartment abscesses and swelling. 

Case Discussion

Chronic osteomyelitis of the thigh with many characteristic findings:

  • cortical thickening/irregularity
  • sequestrum
  • sinus tract
  • soft tissue abscess

At first glance, this may look like and osteosarcoma. However, the presence of a sequestrum, sinus tract, and abscess provide reassurance that this is chronic osteomyelitis. 

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