余永强---骨髓炎学案.ppt

* * * * * * * * * * * * * * * * * * Figure 115: Developing calcaneal osteomyelitis in a 63 year-old diabetic patient. a) Lateral radiograph of the calcaneus shows intact cortex along the plantar surface (white arrowheads). Incidentally seen is mural calcification of the posterior tibial artery. Such arterial calcifications are common in diabetic patients. b) Mid-sagittal T1 image shows no bone destruction. c) Corresponding sagittal Inversion Recovery image shows little if any bone marrow edema. d) Corresponding sagittal post IV contrast T1 fat-suppressed image reveals diffuse enhancement of the plantar soft tissues, indicative of cellulitis, but no non-enhancing abscess pockets. * When the patient’s symptoms did not respond to antibiotics, repeat imaging was obtained 2 weeks later. e) Lateral radiograph now demonstrates loss of cortex along the plantar surface of the calcaneus (black arrowheads). f) Mid-sagittal T1 image reveals infiltration of the fatty heel pad (gray arrows). g) Corresponding sagittal Inversion Recovery image reveals fluid bright signal (white arrows) within the soft tissues adjacent to the calcaneus, as well as bone marrow edema within calcaneus (white arrowheads). h) Corresponding sagittal post IV contrast T1 fat-suppressed image reveals a non-enhancing abscess pocket (black arrows) as well as enhancing bone marrow (white arrowheads). * Coronal T1 (i), Inversion Recovery (j) and post IV contrast T1 fat-suppressed (k) images through the abscess pocket confirm the findings seen in the sagittal plane: an abscess pocket (white and black arrows) adjacent to the osteomyelitis (white arrowheads) along the planter surface of the calcaneus. * * Figure 116: Brodie’s abscess in a young child. a) AP radiograph of the asymptomatic right leg. b) AP radiograph of the swollen left leg reveals a lucency in the distal fibula metaphysis (white arrow in the magnified dashed box). This lucency has a well-defined and sclerotic margin, indicating chronicity. There ar