A Patient has history of RTA 2 years back, at the same site he developed pain and swelling in the leg. X-ray shows the following features. What will be the diagnosis?
Correct Answer: Chronic osteomyelitis
Description: (C) Chronic osteomyelitisAs the given question, case history suggestive of typical sub-acute haematogenic osteomyelitis, otherwise known as Brodie's abscess[?]BRODIE ABSCESS is a subacute osteomyelitis, which may persist for years before converting to a frank osteomyelitis. Classically, this may present after conversion as a draining abscess extending from the tibia out through the shin. Its relative mildness is presumably due to the organism being less virulent or the patient more resistant (or both).Pathology: Typically there is a well-defined cavity in cancellous bone - usually in the tibial metaphysis - containing glairy seropurulent fluid (rarely pus). Surrounding bone trabeculae are often thickened.Clinical features:Patient is usually a child or adolescent who has had pain near one of the larger joints for several weeks or even months.WBC count and blood cultures usually show no abnormality but the ESR is sometimes elevated.Imaging:Typical radiographic lesion is a circumscribed, round or oval radiolucent 'cavity' 1-2 cm in diameter.Most often it is seen in the tibial or femoral metaphysis, but it may occur in the epiphysis or in one of the cuboidal bones (e.g. the calcaneum).Sometimes the 'cavity' is surrounded by a halo of sclerosis (the classic Brodie's abscess); occasionally it is less well defined, extending into the diaphysis. The radioisotope scan shows markedly increased activity.Diagnosis: In about half the cases and the organism is almost always Staphylococcus aureus.Treatment: Conservative if the diagnosis is not in doubt. Immobilization and antibiotics (flucloxacillin and fusidic acid) intravenously for 4 or 5 days and then orally for another 6 weeks usually result in healing, though this may take up to 12 months.If the diagnosis is in doubt, an open biopsy is needed and the lesion may be curated at the same time.Curettage is also indicated if the x-ray shows that there is no healing after conservative treatment; this is always followed by a further course of antibiotics.Other Options: Radiological features[?]Osteosarcoma:MC malignant primary bone tumor in young adults + children; 2nd MC primary malignant bone tumor after multiple myeloma.Neoplastic tissue is radiolucent, Periosteal reaction shows 'Codman's triangle', Zone of transformation is fairly large, "sun-ray" appearance is characteristic (produced by thin radiopaque spicules of bone, radiating away from the cortex of the bone), large soft tissue swelling.[?]Ewing's Sarcoma:MC malignant bone tumor in children; 8-10 cm long lytic lesion in shaft of long bone.Mottled "moth-eaten" destructive permeative lesion; Penetration into soft tissue (55%) with preservation of tissue planes.Early fusiform lamellated "onionskin" periosteal reaction (53%) spiculated & "sunburst" & "hair-on-end" (23%), Codman triangle, Cortical thickening, Cortical sequestration, Reactive sclerotic new bone, Bone expansion.[?]Multiple Myeloma:Generalized osteoporosis with accentuation of trabecular pattern.Punched out appearance of widespread osteolytic areas with endosteal scalloping & uniform size, Diffuse osteolysis, Expansile osteolytic lesions in ribs, pelvis, long bones, Soft-tissue mass adjacent to bone destruction.Sclerosis may occur after chemotherapy, radiotherapy, fluoride administration.Sclerotic form of multiple myeloma is associated with Polyneuropathy, Organomegaly, Endocrine abnormalities, M-protein, Skin changes.
Category:
Orthopaedics
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