Answer for BIR CoW 21 Feb 2021
Garre`s osteomyelitis tibia
Findings
Plain radiograph reveals cortical thickening with sclerosis in the proximal shaft of tibia , involving the meta diaphyseal regions. MRI of the leg reveals Intramedullary T1 hypointensities & STIR hyper intensities(reflecting Bone marrow infiltration) with cortical thickening( more in the anteromedial aspect )noted involving the tibial epiphysis, metaphysis and proximal diaphysis with narrow zone of transition noted with areas of restricted diffusion. Irregularities noted in the tibial articular surface . No adjoining abscesses or sinus tracks noted These findings are consistent with Chronic sclerosing osteomyelitis of left tibia.
Discussion
Primary chronic sclerosing osteomyelitis was first described by Garré in 1893 with thickening of the cortices and loss of the medullary canal, but no features of acute infection such as suppuration, bony sequestra or drainage tracts Garré’s osteomyelitis is a rare inflammatory disease of chronic nature, characterized by periosteal reactions, which induces bone neoformation. It mainly affects the region of the mandible and, in rare cases, may be located in the metaphyseal region of the long bones. The clinical condition is characterized by an insidious start, with local pain and reaction in the affected bone. The symptoms have an episodic non-progressive nature and may persist for several months. The radiographic changes include obliteration of the marrow cavity with widening of the cortex associated with increased bone density. Involvement can be multifocal and in the active phase inflammatory markers, including C reactive protein (CRP) or erythrocyte sedimentation rate (ESR), may be raised. Histological findings show chronic, non-specific osteomyelitis with negative blood and tissue cultures. Learning points Chronic sclerosing osteomyelitis is a rare condition that affects young children and adults. It most commonly affects males and has a preponderance for the tibia. It usually presents to clinicians after a period of moderate pain around the site of bone involvement and has an insidious onset with symptoms recurring at any time. Treatment is mainly symptomatic with some patients responding temporarily to analgesia. Surgical options include: debridement of the bone with exposure of the medulla, resection of the area of chronic osteomyelitis, excision with bone grafting and wire fixation or intramedullary reaming and nailing
Findings
Plain radiograph reveals cortical thickening with sclerosis in the proximal shaft of tibia , involving the meta diaphyseal regions. MRI of the leg reveals Intramedullary T1 hypointensities & STIR hyper intensities(reflecting Bone marrow infiltration) with cortical thickening( more in the anteromedial aspect )noted involving the tibial epiphysis, metaphysis and proximal diaphysis with narrow zone of transition noted with areas of restricted diffusion. Irregularities noted in the tibial articular surface . No adjoining abscesses or sinus tracks noted These findings are consistent with Chronic sclerosing osteomyelitis of left tibia.
Discussion
Primary chronic sclerosing osteomyelitis was first described by Garré in 1893 with thickening of the cortices and loss of the medullary canal, but no features of acute infection such as suppuration, bony sequestra or drainage tracts Garré’s osteomyelitis is a rare inflammatory disease of chronic nature, characterized by periosteal reactions, which induces bone neoformation. It mainly affects the region of the mandible and, in rare cases, may be located in the metaphyseal region of the long bones. The clinical condition is characterized by an insidious start, with local pain and reaction in the affected bone. The symptoms have an episodic non-progressive nature and may persist for several months. The radiographic changes include obliteration of the marrow cavity with widening of the cortex associated with increased bone density. Involvement can be multifocal and in the active phase inflammatory markers, including C reactive protein (CRP) or erythrocyte sedimentation rate (ESR), may be raised. Histological findings show chronic, non-specific osteomyelitis with negative blood and tissue cultures. Learning points Chronic sclerosing osteomyelitis is a rare condition that affects young children and adults. It most commonly affects males and has a preponderance for the tibia. It usually presents to clinicians after a period of moderate pain around the site of bone involvement and has an insidious onset with symptoms recurring at any time. Treatment is mainly symptomatic with some patients responding temporarily to analgesia. Surgical options include: debridement of the bone with exposure of the medulla, resection of the area of chronic osteomyelitis, excision with bone grafting and wire fixation or intramedullary reaming and nailing
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
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Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!