Distal femoral osteomyelitis and sub-periosteal abscess

Case contributed by Dr Mohammad A. ElBeialy


Left-sided limping with fever. The clinician was concerned about a left hip lesion. Ultrasound and plain x-ray of the left hip were normal and MRI was arranged.

Patient Data

Age: 4 years
Gender: Female

Erosion of the medial distal left femur with focal cortical destruction and periosteal reaction.

Normal left hip joint.

  • Altered marrow signal intensity of the distal left femur with low T1 and hyper intense T2 and PDFS signals. A focal destruction of the posteromedial distal femoral cortex is noted with elevated periosteum and periosteal reaction as well as subperiosteal 3.0 x 1.2 cm. cystic collection is noted with low T1 and hyper intense PDFS signal intensity.  
  • Inflammatory changes with edema signal and mild muscle enlargement are seen within the distal thigh and periarticular musculature with hypointense T1 and hyperintense T2 and PDFS signal.
  • Normal both hip joints with no evidence of significant joint effusion or septic arthritis.
  • The findings are those of distal femoral osteomyelitis with subperiosteal abscess and inflammatory myositis of the distal thigh muscles.

Case Discussion

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Case information

rID: 38589
Published: 8th Sep 2015
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

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