0:00

This an eight year old who's having pain, swelling,

0:05

and hyperemia over the distal aspect of the index

0:10

finger with questionable history of a penetrating

0:15

injury in this area.

0:18

Key elements on coronal T one weighted images,

0:22

we can see that there is complete marrow replacement of the

0:27

distal phx of the index finger.

0:29

If you compare to the other OS structures in the field of view,

0:35

T one weighted images should demonstrate fatty marrow signal

0:40

within the medullary canal,

0:42

even in a an eight year old and she should already have fatty

0:47

marrow conversion.

0:49

And you can see how there is extensive replacement of the marrow in this

0:54

index, distal phalanx. And very important as well.

0:58

There is inde thickness of the cortical outline on

1:03

fluid sensitive sequences. This is a sagittal ster.

1:07

We can see the perme pattern of bone destruction that

1:12

is present throughout the distal phalanx of the index

1:16

finger in this patient with an associated fluid collection

1:21

that is abiding the palmer cortex of the distal phalanx.

1:26

And on post contrast images here in the Sal plane demonstrates peripheral

1:31

thick grind of enhancement in keeping with an associated

1:36

abscess.

1:37

So what is a key element in the diagnosis here is the

1:42

replacement of the marrow signal on T one weighted images,

1:46

the diffuse

1:49

marma on fluid sensitive sequences on aster images and the

1:54

associated drainable soft tissue abscess

1:58

adjacent to the area of osteomyelitis.

2:03

We have to keep in mind that osteomyelitis may spread across

2:07

joint spaces,

2:09

so it's very important to check the integrity of the distal

2:13

interphalangeal joint in this patient.

2:16

The growth plate is providing a boundary for the

2:21

disease to stop at the level of the phases.

2:25

So there is no associated septic arthritis of the

2:31

interal interphalangeal joint in this patient,

2:34

the associated cellulitis, which was what was seen clinically.

2:39

You can see the, uh,

2:40

enhancement of the skin and subcutaneous fat throughout, uh,

2:45

the index finger. So in summary,

2:47

we have a patient with cellulitis and MR findings

2:52

of osteomyelitis involving the distal phx of the

2:57

index with an associated drainable soft tissue.