Osteomyelitis

Case contributed by Dr Jeremy Jones

Presentation

Limping. Not using left leg. Pyrexia.

Patient Data

Age: 2 years
Gender: Male
Modality: X-ray

There is a focal lucency on the lateral margin of the metaphysis adjacent to the physis. The epiphysis appears normal. The femoral head on the left appears slightly lateral decentered suggesting an underlying hip effusion. Features here are of osteomyelitis.

Modality: Ultrasound

Ultrasound confirms a hip effusion.

Modality: MRI

The metaphyseal focal lucency on the plain film is demonstrated as a T2 hyperintense, T1 hypointense ring enhancing lesion with surrounding enhancing oedema and a hip effusion. This confirms osteomyelitis as the most likely cause.

Case Discussion

Osteomyelitis in children favours the metaphyseal regions because they are hypervascular and consist of small vessels. The small vessels are the most likely place for relative stasis of infected blood to occur and thus, the most commonly encountered focus of bone infection.

Blood markers for infection were elevated and blood cultures positive for Strep pneumoniae.

Pain resolved following treatment with IV antibiotics. 

Repeat plain film (not provided) revealed sclerosis and healing at the femoral metaphysis.

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Case Information

rID: 27282
Case created: 27th Jan 2014
Last edited: 12th Mar 2016
Inclusion in quiz mode: Included

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