Chronic osteomyelitis of the left femur




Clinical History: An 11-year old boy with left thigh pain for 3 days


Diagnosis: Chronic osteomyelitis of the left femur


MR Technique:

Imaging of the left lower extremity was performed on a 3T (Skyra) MR system. (A) Coronal T2-weighted TIRM (TR/TE 3000/38ms), (B) sagittal T2-weighted TIRM (TR/TE 2800/38), (C) axial T1-weighted TSE (TR/TE 600/12) and (D) axial T2-weighted TSE with Dixon fat suppression (TR/TE 2600/90) scans were acquired before the administration of intravenous contrast. Thereafter, contrast-enhanced T1-weighted TSE (TR/TE 700/11ms) images were acquired in three orthogonal planes with Dixon fat suppression (E-G).


Imaging Findings:

There is an extensive abnormality involving the marrow in the left femur, with slight diaphyseal expansion. The area of abnormality has slight low to intermediate signal intensity on T1WI and very high signal intensity on T2WI. The lesion does not cross the epiphyseal plate distally, of the left femur, and the epiphysis demonstrates normal signal intensity. A slight periosteal reaction can be seen on the T2WI. However, no mass or edema is seen in the surrounding soft tissue. On the contrast-enhanced MRI, patchy enhancement is seen within the area of involved bone marrow. Tissue pathology revealed chronic osteomyelitis.