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Osteomyelitis Originating In and Around Bone Infarcts

Giant Sequestrum Phenomena

Marcia F. Blacksin1, Kathleen C. Finzel2 and Joseph Benevenia3

1 Department of Radiology, University of Medicine and Dentistry of New Jersey, University Hospital, Rm. C320, 150 Bergen St., Newark, NJ 07103-2426.
2 Department of Radiology, SUNY Stony Brook, L-4 Health Sciences Center, Stony Brook, NY 11794-2906.
3 Department of Orthopedic Surgery, University of Medicine and Dentistry of New Jersey, Newark, NJ 07103-2426.



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  		Fig. 1A. —54-year-old woman with Staphylococcus aureus osteomyelitis. Frontal radiograph of left knee shows cortical thickening (open arrows), lytic lesion (arrowheads), and bone infarct (solid arrows).

 


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  		Fig. 1B. —54-year-old woman with Staphylococcus aureus osteomyelitis. CT scan of distal femoral shafts shows cortical thickening (arrows) and sclerotic borders (arrowheads) of bilateral bone infarcts.

 


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  		Fig. 1C. —54-year-old woman with Staphylococcus aureus osteomyelitis. CT scan of supracondylar region of left knee shows cortical destruction (large arrowhead) and osteolysis within borders (small arrowheads) of infarct.

 


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  		Fig. 2A. —43-year-old man with Staphylococcus aureus infection. IV contrast-enhanced CT scan of left distal femur shows rim-enhancing abscesses (small arrowheads) in soft tissues and enhancement of synovium (large arrowheads) lining the surapatellar bursa. Increased attenuation (open arrow) is also noted in medullary cavity consistent with site of infection. Medullary cavity on right side is normal.

 


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  		Fig. 2B. —43-year-old man with Staphylococcus aureus infection. Sagittal T1-weighted MR image (TR/TE, 551/16) shows bone infarct (arrowheads) in proximal tibia and inferior border of distal femoral infarct (open arrow). Cortical destruction (curved arrow) is seen opening into abscess. Distal femoral infarct is low signal centrally (straight arrows) compared with tibial infarct.

 


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  		Fig. 2C. —43-year-old man with Staphylococcus aureus infection. Coronal fat-suppressed fast spin-echo MR image (2640/92) shows "double-line" sign at border of infarct (black arrowheads) with increased signal intensity (arrows) inside infarct. Note infarct (white arrowheads) in proximal tibia.

 


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  		Fig. 3A. —50-year-old man with Mycobacterium tuberculosis osteomyelitis. Frontal radiograph of left hip shows oval lytic lesion (arrow-heads) in proximal femoral shaft.

 


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  		Fig. 3B. —50-year-old man with Mycobacterium tuberculosis osteomyelitis. Coronal fast spin-echo MR image (TR/TE, 5000/90) shows bone infarct (arrow) in marrow cavity of left femur surrounded by low-signal-intensity process in marrow (arrowheads).

 


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  		Fig. 3C. —50-year-old man with Mycobacterium tuberculosis osteomyelitis. Coronal fast spin-echo inversion-recovery MR image (5166/36; inversion time, 150 msec) shows no change in appearance of infarct (solid arrow) and increased signal intensity in surrounding marrow (arrowheads). Note abscess (open arrow) adjacent to greater trochanter.

 


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  		Fig. 4A. —7-year-old boy with methicillin-resistant Staphlococcus aureus osteomyelitis. Axial T1-weighted image MR image (TR/TE, 500/14) in distal tibia shows infarct (arrowheads) with central low signal intensity.

 


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  		Fig. 4B. —7-year-old boy with methicillin-resistant Staphlococcus aureus osteomyelitis. Axial fat-suppressed fast spin-echo MR image (5000/90) shows increased signal inside infarct (open arrow). Note subperiosteal abscesses (arrowheads) around tibia and fibula and edema (white arrows) in flexor and extensor muscles.

 

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