Femur osteomyelitis and thigh abscesses

Case contributed by Dr Mohamed Mahmoud Elthokapy

Presentation

Known immunocompromised patient presented by fever ,painful right thigh swelling and discharge.

Patient Data

Age: 25 years
Gender: Male

Extensive multiple eccentric intramedullary encysted collections (Brodies abscesses) are seen implicating most of right femur shaft and lower metaphyseal region eliciting heterogeneous low T1, high T2 and intensely bright STIR signal. The largest locule measures 2.2x2.5x20 cm along its maximum AP, TS & CC dimensions respectively. They are seen extending to lower metaphyseal region yet no gross intra-articular extension at limited visualized cuts. Marked thinning out of the overlying anterolateral cortex with multiple cortical breaching, periosteal reaction and associated large para-osseous multi-loculated encysted collections with coarse septae the largest pocket about 14 cm long and 5 cm thickness blending imperceptibly with surrounding muscles mainly vastus intermedius and lateralis. Marked surrounding marrow edema is seen markedly extending all over the thigh.

Case Discussion

MRI findings are impressive of an extensive active inflammatory process involving right femur and thigh soft tissue components.

Bone marrow edema, intramedullary abscess formation, soft tissue inflammation, cloaca formation and cortical destructive changes are characteristic for osteomyelitis.

Ultrasound guided aspiration of intermuscular encysted collection revealed pus content.

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