ORTHOPAEDICS

Imaging Findings

CT was highly suggestive of an osteoid osteoma. An MRI was performed, it shows para-osteal abscess with bone marrow involvement.

Diagnosis

Sclerosing Osteomyelitis

Discussion

An invading organism may attack bone by direct invasion from an infected wound, or from an infected joint, or may gain access by hematogenous spread. In infants, Streptococcus is common, while in adults Staphylococcus is more common.

Early imaging findings include soft-tissue changes, easily seen on CT/ MR scanning, and osteoporosis (within 10-15 days of onset of symptoms).

Involucrum is usually visualized after 3 weeks, and is more prolific in children than in adults. Sclerosing osteomyelitis is manifested by gross sclerosis in the absence of apparent bone destruction, and is frequently mistaken for osteoid osteoma.

Contribution

Dr. Ashok Raghavan, Manipal Hospital, Bangalore.