Extramedullary fat fluid level on MRI as a specific sign for osteomyelitis

Hui, Cathryn; Naidoo, Parm

doi:10.1046/j.1440-1673.2003.01217.x

Cited by 25 publications

(14 citation statements)

References 2 publications

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“…The first is on computed tomography within osteomyelitis of the distal femur [20]. The second is a fat-fluid level within the soft tissues adjacent to acute osteomyelitis where the fat globules have been released through a breach in the cortex [21]. A similar appearance is seen in Fig.…”

Section: Discussionmentioning

confidence: 84%

Intramedullary and extramedullary fat globules on magnetic resonance imaging as a diagnostic sign for osteomyelitis

2005

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We retrospectively studied the frequency of persistent foci of fat signal on magnetic resonance (MR) imaging in osteomyelitis to assess its frequency, cause and diagnostic value. The radiographs and MR scans of 100 patients with a final diagnosis of osteomyelitis referred to a specialist orthopaedic oncology service with the presumptive diagnosis of a bone tumour were reviewed. The MR signal and morphological characteristics were recorded with particular attention to the presence of persistent fat signal within the infected area, which was classified as diffuse or focal. Seventeen cases were classified on radiographic grounds as acute, 63 as subacute and 20 as chronic osteomyelitis. In the acute group 12 (70%) showed replacement of the marrow with fluid containing residual fatty signal, diffuse in seven and focal in five cases. Two cases showed predominantly fatty marrow with very early marrow oedema and three cases (18%) showed replacement of marrow fat with fluid and no residual fatty foci. None of the subacute group showed foci of fatty signal and two cases of inactive sclerosing osyeomyelitis in the chronic group showed restoration of normal marrow. Persistent fatty signal within the bone as well as soft tissues on MR imaging is a frequent finding in acute osteomyelitis. Radiological-pathological correlation suggests that the increasing intramedullary pressure leads to septic necrosis with death of the lipocytes and release of free fatty globules. This characteristic, but not pathognomonic, MR finding supports the diagnosis of osteomyelitis and may help to exclude the presence of a tumour.

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Section: Discussionmentioning

confidence: 84%

Intramedullary and extramedullary fat globules on magnetic resonance imaging as a diagnostic sign for osteomyelitis

2005

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“…There has also been a report of a case of extramedullary soft tissue fat-fluid level adjacent to a focus of acute OM supposed to be due to the release of medullary fat globules into the surrounding soft tissues through a breach in the cortex. 7 Extramedullary fat globules in acute OM were also described by Davies et al 6 However, the intramedullary fat signal is not specific to OM alone and can be seen in medullary infarction, Paget disease, Gaucher disease, and in sarcomas after chemotherapy or radiotherapy. Phlegmon formation can be differentiated from abscesses with high accuracy by using fat-suppressed gadoliniumenhanced images.…”

Section: Acute Ommentioning

confidence: 82%

Magnetic Resonance Imaging of Appendicular Musculoskeletal Infection

Lalam

Cassar‐Pullicino

Tins

2007

Topics in Magnetic Resonance Imaging

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Appendicular skeletal infection includes osseous and extraosseous infections. Skeletal infection needs early diagnosis and appropriate management to prevent long-term morbidity. Magnetic resonance imaging is the best imaging modality to diagnose skeletal infection early in most circumstances. This article describes the role of magnetic resonance imaging in relation to the other available imaging modalities in the diagnosis of skeletal infection. Special circumstances such as diabetic foot, postoperative infection, and chronic recurrent multifocal osteomyelitis are discussed separately.

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“…In addition, an extramedullary fatfluid level is a rare but specific sign for osteomyelitis. This sign is an indication of cortical breach and, thus, in the absence of trauma, helps confirm the presence of osteomyelitis (32). CT is considered superior to MR imaging in the setting of chronic osteomyelitis for the demonstration of cortical destruction and gas (Fig 21) (33).…”

Section: Osteomyelitismentioning

confidence: 99%

Musculoskeletal Infection: Role of CT in the Emergency Department

Fayad

Carrino²,

Fishman³

2007

RadioGraphics

179

103

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Musculoskeletal infection is commonly encountered in the emergency department and can take many forms, depending on the involvement of the various soft-tissue layers, bones, and joints. Infection may manifest as superficial cellulitis, necrotizing or nonnecrotizing fasciitis, myositis, a soft-tissue abscess, osteomyelitis, or septic arthritis. Because clinical parameters for the detection of musculoskeletal infection generally lack sensitivity and specificity, computed tomography (CT) plays an important role in the assessment of potential musculoskeletal infections in the emergency department. CT provides an analysis of compartmental anatomy, thereby helping to distinguish among the various types of musculoskeletal infection and to guide treatment options. Specific imaging features exist that help identify the numerous forms of infection in the bones and soft tissues, and CT is invaluable for detecting deep complications of cellulitis and pinpointing the anatomic compartment that is involved by an infection. Although all patients with musculoskeletal infection will require treatment with antibiotics, CT helps guide therapy toward emergency surgical débridement in cases of necrotizing fasciitis and toward percutaneous drainage in cases of abscess formation.

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Extramedullary fat fluid level on MRI as a specific sign for osteomyelitis

Cited by 25 publications

References 2 publications

Intramedullary and extramedullary fat globules on magnetic resonance imaging as a diagnostic sign for osteomyelitis

Intramedullary and extramedullary fat globules on magnetic resonance imaging as a diagnostic sign for osteomyelitis

Magnetic Resonance Imaging of Appendicular Musculoskeletal Infection

Musculoskeletal Infection: Role of CT in the Emergency Department

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