Saturday, June 21, 2008

Radiographic appearance in Osteomyelitis

    • Periosteal reaction
      • Thin, linear periosteal reaction
      • Thick periosteal reaction
      • Laminated—"onion peel"
      • Codman's triangle—periosteum forms bone only at the margins of the periosteal triangle
    • Bone destruction
      • Permeating bone lesion
      • Punched-out bone
      • Moth-eaten
      • Geographic
      • Aggressive osteolysis
      • Well-defined osteolytic lesion with thick sclerotic border
    • Localized cortical thickening
    • Involucrum
      • Reactive new bone surrounding sequestrum
    • Ground-glass
    • Diffusely dense bones
  • CT—for evaluation of
    • Chronic disease
    • Soft tissue expansion
    • Sequestra
    • Sinus tracts
  • MR—relative to X-ray
    • Increased sensitivity
    • Decreased specificity
  • Nuclear Medicine
    • Tc99m-MDP bone scan
      • More sensitive than plain film
      • Negative rules out osteomyelitis
      • Phases (osteomyelitis positive through all 3 phases, cellulitis is negative on delayed)
        • Flow
        • Blood pool
        • Delayed
    • If underlying bone abnormal (i.e. diabetic foot, fractures, nonunion, pseudoarthroses, hardware) use multiple isotope scintigraphy (Tc99m-MDP combined with the agents listed below)
      • Sulfur colloid
        • Defines extent of red marrow
      • Labeled WBC's (Indium-111 or Tc99m-HMPAO)
        • Infection suggested by
          • Activity in absence of sulfur colloid activity
          • Greater activity than that of sulfur colloid
        • If activity of labeled WBC's and sulfur colloid ~equal, probably just marrow not infection
      • Gallium
        • Used in place of labeled WBCs
        • Less effective
  • Risk factors
    • Penetrating trauma
    • Immunocompromised
    • IV drug abuse
    • Diabetes mellitus
    • Sickle cell disease
  • Sequestrum and/or abscess
    • Antibiotics and surgical drainage
  • In patients <>


  1. Weissleder et al, Primer of Diagnostic Imaging, 4th edition, 2007.
  2. Bookstein, Medical Student's Pocket Reference, 4th edition, 2002.
  3. Brant & Helms, Fundamentals of Diagnostic Radiology, 3rd edition, 2006.
  4. STATdx, url: (by Amirsys, Inc.).


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Herbs Solutions By Nature said...

Osteomyelitis caused by virulent bacteria that needs to be treated with natural cures or Herbal Treatment of Osteomyelitis. Swelling of the ankles, feet, and legs are the symptoms of osteomyelitis.

Naturalherbs Solutions said...

Alternative and effective Treatment for Osteomyelitis option available and being aware of them is the first step in removing this disease.