Case Of the Week (COW) 01 Sep 2013
Answer:
SUBACUTE OSTEOMYELITIS WITH ABSCESS
Findings:
Focal relatively expansile eccentric lytic lesion noted in the anterolateral aspect of distal tibial meta epiphysis abutting the articular surface. It is relatively hyperintense to muscle in T1W1/T2W1 , hyperintense to Bone marrow in STIR and hypointense to Bone marrow in T1/T2WI. However this lesion shows restricted diffusion with low ADC values (0.82). Dynamic contrast enhanced imaging revealed a Type 3 curve with rapid upstroke followed by Plateau. On contrast administration, moderate homogenous contrast enhancement noted in subtracted images. Marrow edema noted in the rest of the epiphysis.
Discussion:
The Features are suggestive of Osteomyelitis with Abscess –Tuberculous etiology. This was confirmed on followup . The clues to the diagnosis were the location, the restricted diffusion and the pattern of time intensity curve.
Contributed By:
Dr. Babu Peter MD, DNB
Associate Professor, Barnard Institute of Radiology
Senior Consultant Radiologist, Aarthi Scans, Chennai
Answer:
SUBACUTE OSTEOMYELITIS WITH ABSCESS
Findings:
Focal relatively expansile eccentric lytic lesion noted in the anterolateral aspect of distal tibial meta epiphysis abutting the articular surface. It is relatively hyperintense to muscle in T1W1/T2W1 , hyperintense to Bone marrow in STIR and hypointense to Bone marrow in T1/T2WI. However this lesion shows restricted diffusion with low ADC values (0.82). Dynamic contrast enhanced imaging revealed a Type 3 curve with rapid upstroke followed by Plateau. On contrast administration, moderate homogenous contrast enhancement noted in subtracted images. Marrow edema noted in the rest of the epiphysis.
Discussion:
The Features are suggestive of Osteomyelitis with Abscess –Tuberculous etiology. This was confirmed on followup . The clues to the diagnosis were the location, the restricted diffusion and the pattern of time intensity curve.
Contributed By:
Dr. Babu Peter MD, DNB
Associate Professor, Barnard Institute of Radiology
Senior Consultant Radiologist, Aarthi Scans, Chennai