0:00

Let's go to the third case.

0:02

So this is the third case in this case.

0:05

Uh, I'm gonna, uh, talk about the, the history in a moment.

0:13

So here it's the, here's the right foot,

0:16

and this is the left ankle.

0:19

Okay? So it's not the same side,

0:22

right foot in your left and the, the,

0:26

and the, uh, left ankle in your right.

0:29

Okay. So we can see some findings that are very similar

0:35

to the, to infection in this areas right here.

0:38

So let's talk a little bit more about the,

0:41

the history of this patient.

0:43

9-year-old female with ankle

0:46

and foot pain for two months.

0:50

So that's the history.

0:51

And we can identify this area right here

0:54

with high signal intensity at the metaphysis of the bone

0:57

with, uh, with, uh, a huge bone edema

1:01

and edema of the soft tissue around.

1:04

And also another area right here at the, at the metaphyseal

1:08

or the proximal, uh, growth plate of the first, uh,

1:13

metatarsal bone of the right foot.

1:15

And when we see, when we saw this case

1:19

and with, uh, the, the, the doctor, uh, the

1:23

hematologist did the workup of this case, it turns out

1:28

to be, uh, chronic, uh, chronic recurrent, uh,

1:34

osteo osteomyelitis.

1:36

Let me put the, the PowerPoint to show some findings

1:40

of this third case.

1:43

So this is the case, 9-year-old female with ankle

1:46

and foot pain for two months.

1:47

And here in the, in, in the, the metaphysis

1:52

of the fibular, the left fibula,

1:54

we can see this lesion infection like lesion

1:57

in this region right here.

1:59

And this is a chronic recurrent mood focal osteomyelitis,

2:03

also known as chronic non bacterial, uh, osteomyelitis.

2:08

I like the second name 'cause it's,

2:10

there's no back bacteria right here.

2:12

It's not a true infection, but it looks like infection.

2:16

What will help you is first you see

2:19

that in two different parts at least.

2:22

So we can see this lesion right here at the left ankle

2:26

and at the right foot, we could see a lesion very similar to

2:31

that, uh, on the right foot.

2:33

That's the first part. That's the first, first part.

2:36

And that led you, uh, lead you to think about this lesion.

2:40

You have to think about this.

2:42

If you see a lesion that looks like infection,

2:45

but it's in di uh, in different places.

2:48

Or if the patient has it, uh, has it like,

2:52

or had it, uh, uh, another time.

2:55

And now it's having, again, we should think about

2:58

The chronic recurrent multifocal osteomyelitis.

3:02

And here is the, the sagittal plane.

3:04

We could see the high signal intensity, uh, uh,

3:07

with contrast enhancement at the base

3:10

of the first metatarsal, uh, bone.

3:13

And here is the tomography of the case showing this, this,

3:18

uh, lytic with cro with sclerotic lesions that looks like,

3:23

uh, osteomyelitis.

3:25

But, uh, in this case, the, uh, I think

3:29

that they did biopsy here.

3:30

It was, uh, there was no, uh, infection.

3:35

And we did like the whole bo uh, whole body MRI too.

3:39

But there was no other areas of, uh, of, uh, lesions.

3:45

And this patient is, uh, is, it's, she's being treated as,

3:50

uh, chronic recurrent mood focal osteomyelitis,

3:53

and she's improving.

3:55

Uh, so that was like the third case

3:57

that I'd like to show you.

3:59

Okay. So when you see a lesion

4:01

that looks like infection in a child

4:04

or in adolescent okay,

4:06

infection, you should think about that.

4:08

But if it occurs in two different place or if it's,

4:12

or uh, it's recurrent, you have to think about, uh,

4:15

the chronic recurrent, uh, mood focal osteomyelitis.