Infected intraosseous foreign body - abscess formation

Case contributed by Ammar Haouimi
Diagnosis almost certain


History of palm thorn injury 1 year ago.

Patient Data

Age: 10 years
Gender: Male

There is a relatively well-defined calcaneal osteolytic lesion with sclerotic margin extending to the sustentaculum tali. No radiopaque foreign body is seen within the soft tissue of the ankle or the foot.

The MRI sequences show an intraosseous linear foreign body within the previously described calcaneal osteolytic lesion. This calcaneal lesion appears well-defined bilobuated of low signal on T1WI, high signal on T2WI with thin and regular peripheral enhancement, extending to the tarsal sinus superiourly. A perilesional bone marrow edema with enhancement is noted. A mild joint effusion in the posterior tibiotalar recess. with synovial enhancement is also noted.

Case Discussion

MRI features of an infected intraosseous foreign body within the calcaneus with abscess formation.

This child was operated a few days later and a palm thorn was removed from the calcaneus.

Such a foreign body cannot be visualized on a plain radiograph (radiolucent) and may require further imaging. Ultrasound also will be difficult in such cases to detect an intraosseous foreign body. The best imaging modality is CT or MRI. CT is better to visualize the foreign body, but if there is infection or abscess formation within the adjacent structures (as in this case), MRI remains superior to CT. 

Additional contributors: R. Bouguelaa MD. A Ramdani, MD.

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