Tag Archives: Osteomyelitis

Back pain…

October 7, 2014

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Back pain is one of the most frequent complaints in the ED.  The vast majority of patients do not have a life threatening or highly morbid pathology.  Unfortunately, this patient did:

 

CT LSpine 1 LS spine 2

This is a CT scan under bone windows.  It shows erosive changes based around the L4-L5 disc, eroding into the inferior endplate of L4 and the superior endplate of L5. These findings are concerning for discitis-osteomyelitis. It is favored to have both acute
and chronic components.

Finding this pathology is somewhat like finding a needle in a haystack.  However, pay attention to signs such as fever, repeat ED visits without a firm diagnosis, focal weakness, and predisposing factors such as IV drug abuse, history of endocarditis, or immunosuppression.  Sedimentation rate and C-reactive protein are often elevated in this disorder (among others).

CT is a readily available, quick way to diagnose this pathology but it isn’t as sensitive as MRI.  Plain films are not reliable but may show changes similar to the CT above.  Nuclear medicine bone scans as well as PET scans can be used but are not commonplace in the ED.

Author:  Russell Jones, MD

Image Contributor:  Zachary Skaggs

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Interesting osteomyelitis…

May 6, 2014

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This patient presented with multiple skin lesions with an ulcerative mass to his thumb…

OM hand

This patient had an ulcerative, indurated lesion to the distal thumb which can be seen on the above radiograph.  The radiograph also demonstrates periostitis and osseous erosion of the distal thumb and metacarpal joint of the thumb.  There are subtle periosteal changes to the third phalanx as well.

It turns out this patient has sporothrix schenkii osteomyelitis.

Author:  Russell Jones, MD

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