0:00

So go to back to one more case

0:02

and if your practice is like mine, your ER physicians like

0:07

to trip you up with odd, uh, histories.

0:11

So this is what we got.

0:13

He had pain

0:14

and felt a pop while stepping off a curb

0:16

for the eagle eyes in the audience, we can not,

0:19

we can see past in these fights here,

0:22

but we can also see this, this

0:25

lucency in the posterior aspect of the calcaneus.

0:29

So like every good ER physician does from the er,

0:33

we get a CT of this region.

0:35

And here we can appreciate this ika that has broken

0:39

through the posterior cortex of the calcaneus

0:43

and into

0:45

and opens up into this large loosen lesion

0:48

in the calcaneal tuberosity.

0:51

A little bit more anteriorly.

0:53

We see the sclerotic foci along the anterior U

0:57

and media aspect of the cavity, which

1:02

represented some areas of sequestrum, uh,

1:05

for this Brody's abscess that has the cloaca posteriorly.

1:10

Unfortunately, for this patient, he did end up having, um,

1:15

some follow-up images

1:16

and so we can see the MRI at the time

1:19

of initial presentation demonstrating the acute

1:23

osteomyelitis involving the posterior calcaneus

1:26

with the interosseous abscess with the cloaca.

1:30

And subsequently he had some aspirations performed, but,

1:35

and multiple treatments.

1:36

But despite all of these, he continued

1:39

to have chronic osteomyelitis.

1:41

This is him a couple months later

1:43

now forming another cloaca along the lateral margin

1:48

of the calcaneus with this sinus tract, uh, opening up

1:53

to this skin surface.

1:55

As we look at the T one post contrast sequence,

1:57

we can see a lot of granulation tissue around, uh,

2:01

where the abscess was located before

2:05

and still areas of low signal intensity, uh,

2:08

within the center of this, which may represent some

2:13

residual sequestrum

2:14

that was not removed from the time of surgery.

2:17

So at the time of, of the initial presentation, we have the,

2:21

uh, axi T one stir and pre and post contrast images.

2:25

And these just nicely, again,

2:26

redemonstrate the osteomyelitis,

2:28

but also, uh, associated abscesses that were starting

2:33

to form along the lateral margin of the calcaneus.

2:37

And these, uh,

2:39

these collections over here in the lateral aspect

2:41

of the foot were, were actually aspirated, but I suspect

2:45

because of its proximity to the bone here, this is what led

2:49

to the formation

2:51

of the sinus tract along the lateral margin of the foot.

2:54

Later on.