Fattore Julia, Goh Daniel Soon Lee, Al-Hindawi Ahmad, Andresen David
St Vincent's Hospital Sydney NSW Australia, 390 Victoria Street Darlinghurst NSW 2010, Australia.
University of New South Wales, University of Notre Dame, St Vincent's Clinical School, Darlinghurst, NSW 2010, Australia.
Radiol Case Rep. 2020 Oct;15(10):2003-2008. doi: 10.1016/j.radcr.2020.07.079. Epub 2020 Aug 22.
The tibia is an atypical site of osteomyelitis (OM) in adults, and patients with this infection experience a significant degree of morbidity as well as the need for prolonged aggressive antibiotic therapy. The early diagnosis of OM remains challenging, and often relies on imaging modalities which are of variable sensitivity. We present a case of a 49-year-old male with a methicillin resistant (MRSa) left tibial OM, contiguous left knee septic arthritis, and concurrent bacteraemia. Eight days after the onset of pain in the left knee and lower limb, conventional radiography and computed tomography (CT) imaging had only subtleties of a soft tissue collection and a knee effusion. A MRI demonstrated significant involvement of his tibial bone with a collection, from which surgical specimens confirmed MRSa. This case demonstrates the difficulty of diagnosing early acute OM with conventional radiography and CT imaging, even after a week of symptoms in the affected limb. Given the poor sensitivity of conventional radiography and CT in the diagnosis of early acute OM, this case report illustrates how MRI is the imaging modality of choice in this setting.
胫骨是成人骨髓炎（OM）的非典型发病部位，患有这种感染的患者会经历相当程度的发病，并且需要长期积极的抗生素治疗。OM的早期诊断仍然具有挑战性，通常依赖于敏感性各异的影像学检查方法。我们报告一例49岁男性，患有耐甲氧西林（MRSa）的左胫骨骨髓炎、连续性左膝化脓性关节炎和并发菌血症。在左膝和下肢疼痛发作8天后，传统X线摄影和计算机断层扫描（CT）成像仅显示有软组织肿物和膝关节积液的细微迹象。磁共振成像（MRI）显示其胫骨骨有大量肿物，手术标本证实为MRSa。该病例表明，即使在患肢出现症状一周后，用传统X线摄影和CT成像诊断早期急性骨髓炎仍有困难。鉴于传统X线摄影和CT在早期急性骨髓炎诊断中的敏感性较差，本病例报告说明了MRI在这种情况下是首选的影像学检查方法。
