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Case Reports
. 2014 Mar;96(2):e13-6.
doi: 10.1308/003588414X13814021678637.

Intracortical haematogenous osteomyelitis

A J L Jowett  1 , S W F Middleton, M C Quaye, H Chesterfield, I Lasrado, F M Witham
Affiliations
Case Reports

Intracortical haematogenous osteomyelitis

A J L Jowett et al. Ann R Coll Surg Engl. 2014 Mar.

Abstract

We present an unusual case of haematogenous osteomyelitis in the diaphysis of the tibia of an adult leading to a subacute presentation with an extracortical abscess. Fluid from the abscess grew methicillin resistant Staphylococcus aureus (MRSA) on culture; MRSA with the same antibiogram had been grown from the patient's blood seven years earlier following a bowel resection. Drainage of the abscess and curettage of the bone lesion together with appropriate antibiotic therapy led to resolution of the osteomyelitis.

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Figures

Figure 1
Figure 1
Frontal radiography of left lower leg showing focal thickening of the lateral cortex of the tibial lower/mid diaphysis, with intracortical lucency
Figure 2
Figure 2
Coronal STIR magnetic resonance imaging showing soft tissue and more subtle bone marrow high signal return of oedema and intracortical lesion of high fluid signal return
Figure 3
Figure 3
Axial fat saturated proton density weighted magnetic resonance imaging showing high fluid signal return in intracortical lesion
Figure 4
Figure 4
Coronal STIR magnetic resonance imaging showing fluid collection behind and adjacent to tibia
Figure 5
Figure 5
T1 weighted, fat saturated, gadolinium enhanced, axial magnetic resonance imaging showing enhancing margin of the collection adjacent to the posterior, lateral and medial surfaces of the tibia
Figure 6
Figure 6
Photograph revealing collection entered and pus exposed between the tibialis anterior (retracted muscle) and the tibia
Figure 7
Figure 7
Photograph revealing the area shown in Figure 6 after the collection had been drained, a small defect in the cortex and a small area of stripped periosteum
See this image and copyright information in PMC

References

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