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This is Pediatrics case 3 week 4

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and the diagnosis were considering is osteomyelitis. So

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as you would expect we're going to look at an MR

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scan.

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Osteomyelitis can be detected on radiograph but

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it's more difficult and it's typically seen when it's

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a more advanced as a disease process. So

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it may involve destruction of the trabecular bone loosen

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sees within the medullary space of the bone or periosteal

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reaction along the cortex of the bone in advanced

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cases. There can be outright bone destruction.

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Certainly secondary effects of infections such as septic arthritis

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and others can be detected on radiograph.

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However, MRI is the gold standard and

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we're going to look at some.

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pre and post contrast Imaging now it turns out

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that

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Contrast is not required to evaluate

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for osteomyelitis with

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MRI. And if you see normal bone

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marrow signal on a non-contrasted MRI, the literature

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suggests. There's no reason to add contrast normal scan

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pre contrast. You can be done. However, if

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you're concerned for complications of

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osteomyelitis, if you want to evaluate for example

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for synovitis in the joint space or

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interosseous abscess or these types of

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sub periosteopsis contrast can offer some

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advantages so

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It can be a useful adjunct particularly in cases where

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there are already signs of disease on the pre contrast Imaging.

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So I'm going to scroll through this coronal image. This is

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a fat saturated image so the

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normal bright T1 signal isn't there but you can see

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already that there's some abnormality in the distal metaphysical femur.

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There's some abnormal bone marrow signal and there's a focal lesion

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right at the level of the fisces itself.

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Maybe it's even involving some of

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the epiphysis I'm going to

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pull up the

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post contrast images of this same region

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And after the administration of contrast for one

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thing we can see that there is enhancement

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of the synovium for another

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thing. We can see a lot of enhancement in this same

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region. This focal space has a rim enhancing appearance

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centrally no enhancement. Now, we're very

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concerned about abscess and it appears to extend into the

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fisces and when we scroll down we can see it even

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touches the epiphysis a little bit. This is a trans visual interosseous

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abscess. There's bone marrow signal changes compatible

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with osteomyelitis if we look over at the sagittal View,

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Here, we've got a nice depiction of

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septic arthritis with this joint space filled with

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Fusion and the synovial lining brightly enhancing

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also some thickening of the synovium. And

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here's that focal region right at the

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level of the fysis where you can see that there's a central

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portion where fluid has accumulated and the

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contrast agent is not able to reach so you can see the Rind of

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this extending here with this Central area of non-enhancing

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fluid the abscess

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fluid itself.

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so this patient has

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several complicating features of osteomyelitis certainly needs

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to be under a surgeon's care. And the last

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thing I'll show is the axial appearance

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of this same disease process, which can be nice

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to give us a sense of the posterior compartment of the knee. This

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is below the knee and then as we come up,

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Above at the level of the femur we can see our

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area of interest posteriorly and we can see

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the enhancement of all of the synovium and retinaculum

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quite brightly.

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That's the end of the case.