Case History: 22-year-old patient presented with complaint of swelling of elbow for six months following trauma. MRI of elbow was performed.
MRI showed marrow edema in humoral condylar and supracondylar region and cortical breakdown and fluid collection in and around joint.
Figure 1a. Cortical breakdown in ulna.
Figure 1b. Marrow edema and cortical thinning in humoral condylar and supracondylar region.
Figure 1c. Marrow edema and cortical thinning in humoral condylar and supracondylar region.
Figure 2. T2Wi showing collection in and around joint.
Figure 3. STIR image showing collection in and around joint.
Figure 4. T2Wi showing collection in and around joint.
Figure 5. STIR image showing collection in and around joint.
Figure 6. STIR image showing collection in and around joint.
In most instances, osteomyelitis results from a hematogeneous spread.
The location of osteomyelitis within a bone varies with age, due to changing blood supply.
In general, osteomyelitis must extend at least 1 cm and compromise 30% to 50% of bone mineral content to produce noticeable changes in plain radiographs.
CT is superior to both MRI and plain film in depicting the bony margins and identifying a sequestrum/involucrum.
Although ultrasound excels as a fast and cheap examination of the soft tissues, and allows soft tissue collections to be drained, it has less of a direct role in the assessment of osteomyelitis, as it is unable to visualize within the bone.
A number of techniques may be employed to detect foci of osteomyelitis.
FDG-PET may have the highest diagnostic accuracy for confirming or excluding chronic osteomyelitis in comparison with bone scintigraphy, MRI, or leukocyte scintigraphy.
Treatment is typically with intravenous antibiotics, usually for extended periods.
