Emphysematous osteomyelitis is a rare condition characterized by the presence of intraosseous gas. A prompt diagnosis is required for this disease to expedite management as it is a potentially fatal condition. Many comorbidities, such as malignancy, diabetes mellitus, alcohol abuse, Crohn's disease, and other etiologies causing immunosuppression, predispose to this condition. The causative organisms are generally anaerobes or members of Enterobacteriaceae family; however, the infection can be mono or polymicrobial. We report two cases affected with emphysematous osteomyelitis due to varied underlying comorbidities. The purpose of this study is to (a) emphasize the importance of computed tomography in diagnosing emphysematous osteomyelitis and (b) to highlight an unusual location of this rare pathology.

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Background: Endoscopic ultrasound-guided liver biopsy (EUS-LB) has emerged as a viable mean to obtain core tissue. Different wet suction techniques using saline or heparin have been described. We aimed to compare tissue adequacy with the “wet saline” (WS) technique compared to the “wet heparin” (WH) technique.Methods: We conducted a retrospective review of patients who underwent EUS-LB and Percutaneous liver biopsy (PLB-LB) for benign parenchymal liver disease between May 2017 to October 2019. All procedures were performed at a single tertiary Veterans Affairs Medical Center (VAMC).Results: A total of 257 biopsies from 217 patients were included. Among the 102 EUS-LB specimens, 53 were obtained using WS technique and 49 were obtained using WH technique. Specimen adequacy was similar in the both groups. Median ASL and length of longest piece did not differ significantly between both groups. Clots were present more frequently in the WS group. Among patients who underwent EUS-LB of both right and left liver lobes, an adequate biopsy was obtained in 85% of patients in the WS group and 96% of patients in the WH group. EUS-LB showed lower risk of post procedural pain and complication rates when compared with percutaneous liver biopsy (PLB). To our knowledge, this is the first study to compare diagnostic accuracy between WH and WS EUS-LB techniques, and to compare post-procedure pain between EUS-LB and moderate sedation PLB. WH-EUS-LB may be preferable to WS because of fewer clots in the specimen. Prospective studies are needed to further verify these findings.

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