What’s the Diagnosis – Case 56
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What’s the Diagnosis – Case 56
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What’s the Diagnosis – Case 56
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Findings Radiographs demonstrate a marked degree of osteopenia centered about the left hip joint with a severe degree of circumferential joint space loss. A fibular strut graft is seen extending into the femoral head. The MR images demonstrate a large joint effusion with an aggressive type synovial response with a lamellated type pattern. There is a marked amount of edema in the bone, particulary the femur, as well as extending into the soft tissue. Focal areas of bony destruction are seen and there is a profound degree of cartilage loss. Other defects are seen of the proximal femur related to removal of previous orthopedic hardware.
What’s the Diagnosis – Case 56
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What’s the Diagnosis – Case 56
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What’s the Diagnosis – Case 56
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What’s the Diagnosis – Case 56
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What’s the Diagnosis – Case 56
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What’s the Diagnosis – Case 56
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Diagnosis: Septic arthritis/osteomyelitis
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Infection is a devastating process which can lead to a rapid obliteration of articular cartilage or in the postoperative setting can lead to significant morbidity and mortality. In our practice, we have found a relative sensitive and specific sign of septic arthritis manifest by an aggressive or lamellated synovitis as demonstrated in this case. Additional findings of a large joint effusion, edema in the adjacent subchondral bone, and edema extending into the adjacent soft tissues effacing normal soft tissue planes assist in the diagnosis. On radiographs, the infectious process often manifests as osteopenia related to a marked degree of hyperemia. The precipitous cartilage loss leads to the marked degree of joint space loss.
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Osteomyelitis may accompany or occur separately from a septic joint. On MR examination, the presence of edema alone in the bone may relate to infection or a reactive process. However, the presence of bony destruction indicates osteomyelitis. The presence or absence of soft tissue or osseous fluid collections (abscesses) is of great concern given their relative inability to be treated with antibiotics alone and frequently necessitating surgical debridement.
What’s the Diagnosis – Case 56
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