1.M. chelonae Soft Tissue Infection Spreading to Osteomyelitis.
Ryuh Sup KIM ; Jun Sik KIM ; Dong Hoon CHOI ; Do Seung KWON ; Jae Hoon JUNG
Yonsei Medical Journal 2004;45(1):169-173
A previously healthy, 54-year-old woman presented with Mycobacterium chelonae soft tissue infection and osteomyelitis of her left lower leg. The infection had started from soft tissue emerging at the medial aspect of the distal femur and had spread through the bone because of delayed diagnosis. The largely indolent, 8-month course to diagnosis was attributable to unremarkable clinical manifestations combined with a low index of suspicion such as immunocompetent patient and/or inadequate finding of acid-fast bacilli in a lesion smear, characteristic histopathological features, and culture techniques. Soft tissue infection and osteomyelitis were successfully treated without surgical intervention and with a 6-month course of chemotherapy.
Female
;
Human
;
Knee Joint/microbiology/radiography
;
Middle Aged
;
Mycobacterium Infections, Atypical/complications/*radiography
;
*Mycobacterium chelonae
;
Osteomyelitis/*microbiology/radiography
;
Soft Tissue Infections/*microbiology/radiography
2.Nocardia osteomyelitis in a pachymeningitis patient: an example of a difficult case to treat with antimicrobial agents.
Kyoo Ho SHIN ; Woo Suk LEE ; Young Ki SON ; Kyungwon LEE ; Yunsop CHONG
Yonsei Medical Journal 1998;39(6):604-610
Antimicrobial agents played a miraculous role in the treatment of bacterial infections until resistant bacteria became widespread. Besides antimicrobial-resistant bacteria, many factors can influence the cure of infection. Nocardia infection may be a good example which is difficult to cure with antimicrobial agents alone. A 66-year-old man developed soft tissue infection of the right buttock and thigh. He was given prednisolone and azathioprine for pachymeningitis 3 months prior to admission. Despite surgical and antimicrobial treatment (sulfamethoxazole-trimethoprim), the infection spread to the femur and osteomyelitis developed. The case showed that treatment of bacterial infection is not always as successful as was once thought because recent isolates of bacteria are more often resistant to various antimicrobial agents, intracellular parasites are difficult to eliminate even with the active drug in vitro, and infections in some sites such as bone are refractory to treatment especially when the patient is in a compromised state. In conclusion, for the treatment of infections, clinicians need to rely on laboratory tests more than before and have to consider the influence of various host factors.
Aged
;
Case Report
;
Drug Resistance, Microbial/physiology
;
Dura Mater/microbiology*
;
Fatal Outcome
;
Femur/radiography
;
Human
;
Male
;
Meningitis/microbiology*
;
Nocardia Infections/physiopathology
;
Nocardia Infections/drug therapy*
;
Osteomyelitis/radionuclide imaging
;
Osteomyelitis/radiography
;
Osteomyelitis/microbiology*
3.Bilateral Brodie's abscess at the proximal tibia.
Halil BULDU ; Fikri Erkal BILEN ; Levent ERALP ; Mehmet KOCAOGLU
Singapore medical journal 2012;53(8):e159-60
Brodie's abscess is a form of subacute osteomyelitis, which typically involves the metaphyses of the long tubular bones, particularly in the tibia. The diagnosis is usually made incidentally, as there are no accompanying symptoms or laboratory studies. Bilateral involvement at the proximal tibia is unusual. However, orthopaedic surgeons should be aware of this entity, as it may present without symptoms. Checking the contralateral limb for concomitant Brodie's abscess is recommended.
Abscess
;
diagnosis
;
Adult
;
Female
;
Humans
;
Osteomyelitis
;
complications
;
diagnosis
;
Radiography
;
Tibia
;
diagnostic imaging
;
pathology
4.Clinical and panoramic radiographic features of osteomyelitis of the jaw: A comparison between antiresorptive medication-related and medication-unrelated conditions
Jeong Won SHIN ; Jo Eun KIM ; Kyung Hoe HUH ; Won Jin YI ; Min Suk HEO ; Sam Sun LEE ; Soon Chul CHOI
Imaging Science in Dentistry 2019;49(4):287-294
PURPOSE: This study was performed to analyze the clinical and imaging features of contemporary osteomyelitis (OM) and to investigate differences in these features on panoramic radiography according to patients' history of use of medication affecting bone metabolism.MATERIALS AND METHODS: The records of 364 patients (241 female and 123 male, average age 66.8±14.9 years) with OM were retrospectively reviewed. Panoramic imaging features were analyzed and compared between patients with medication-related OM (m-OM) and those with conventional, medication-unrelated OM (c-OM).RESULTS: The age of onset of OM tended to be high, with the largest number of patients experiencing onset in their 70s. The 2 most frequent presumed causes were antiresorptive medication use (44.2%) and odontogenic origin (34.6%). On panoramic radiographs, a mix of osteolysis and sclerosis was the most common lesion pattern observed (68.6%). Sequestrum, extraction socket, and periosteal new bone formation were found in 143 (42.1%), 79 (23.2%), and 24 (7.1%) cases, respectively. The m-OM group exhibited sequestrum and extraction socket more frequently and displayed significantly higher mandibular cortical index values than the c-OM group.CONCLUSION: We observed some differences in imaging features as shown on panoramic radiography according to the history of antiresorptive medication use. This study may help elucidate the predictive imaging features of medication-related osteonecrosis of the jaw.
Age of Onset
;
Female
;
Humans
;
Jaw
;
Male
;
Metabolism
;
Osteogenesis
;
Osteolysis
;
Osteomyelitis
;
Osteonecrosis
;
Radiography, Panoramic
;
Retrospective Studies
;
Sclerosis
5.Mycobacterium Kansasii Disease Presenting As a Lung Mass and Bronchial Anthracofibrosis.
Seung Won RA ; Kwang Ha LEE ; Ju Young JUNG ; Ho Suk KANG ; I Nae PARK ; Hye Sook CHOI ; Hoon JUNG ; Gyu Rak CHON ; Tae Sun SHIM
Tuberculosis and Respiratory Diseases 2006;60(4):464-468
The incidence of Mycobacterium kansasii pulmonary diseases are on the increase in Korea with the higher probability of occurrence in middle-aged and older men with underlying lung diseases Among nontuberculosus mycobacterial (NTM) infections, the clinical features of M. kansasii pulmonary infection are most similar to those of tuberculosis (TB). The chest radiographic findings of M. kansasii infection are almost indistinguishable from those of M. tuberculosis (predominance of an upper lobe infiltration and cavitary lesions), even though some suggest that cavities are more commonly thin-walled and have less surrounding infiltration than those of typical TB lesions. Although there are reports on the rare manifestations of M. kansasii infections, such as endobronchial ulcer, arthritis, empyema, cutaneous and mediastinal lymphadenitis, cellulites and osteomyelitis, the association with bronchial anthracofibrosis has not yet been reported. This report describes the first case of M. kansasii infection presenting as a lung mass in the right lower lobe with accompanying bronchial anthracofibrosis.
Arthritis
;
Empyema
;
Humans
;
Incidence
;
Korea
;
Lung Diseases
;
Lung*
;
Lymphadenitis
;
Male
;
Mycobacterium kansasii*
;
Mycobacterium*
;
Osteomyelitis
;
Radiography, Thoracic
;
Tuberculosis
;
Ulcer
6.Usefulness of MR Imaging in Pathologic Fracture of Long Bone.
Hyo Soon LIM ; Jin Gyoon PARK ; Jae Min SONG ; Tae Woong CHUNG ; Woong YOON ; Heoung Keun KANG
Journal of the Korean Radiological Society 2002;47(2):221-225
PURPOSE: The purpose of this study was to evaluate the usefulness of MR imaging of pathologic fractures of the long bones. MATERIALS AND METHODS: In 18 patients aged between four and 75 (mean, 25.8) years with histologically confirmed pathologic fractures of the long bones, plain radiographs and MR images were retrospectively analyzed. The former were examined with regard to location and type of fracture, and the presence or absence of underlying disease causing fracture; and the latter in terms of underlying disease, extraosseous mass formation, and soft tissue change. RESULTS: The long bones involved were the femur in nine patients, the humerus in six, and the tibia in three. Underlying diseases were metastatic tumor (n=6), benign bone tumor (n=5), primary malignant bone tumor (n=4), osteomyelitis (n=2), and eosinophilic granuloma (n=1). Plain radiographs showed the fracture site as the metaphysis in ten cases, the diaphysis in five, and the metadiaphysis in one. Fractures were either transverse (n=10), oblique (n=3), spiral (n=1), vertical (n=1), or telescopic (n=1). In two cases, the fracture line was not visible. MR images revealed underlying diseases in all cases. A solid mass was present in all cases of malignant bone tumor, and an extraosseous mass in five such cases. Two benign bone tumors took the form of a cystic mass, two were a cystic mass containing an enhanced solid portion, and one was a solid mass. A soft tissue hematoma was seen in three cases. CONCLUSION: Where pathologic fracture of a long bone had occurred, or a pathologic fracture in which the findings of plain radiography were equivocal, MR imaging was useful for evaluating the pattern and extent of an underlying lesion.
Diaphyses
;
Eosinophilic Granuloma
;
Femur
;
Fractures, Spontaneous*
;
Hematoma
;
Humans
;
Humerus
;
Magnetic Resonance Imaging*
;
Osteomyelitis
;
Radiography
;
Retrospective Studies
;
Tibia
7.Pyogenic osteomyelitis of long bone: MR findings.
Hye Kyung YOON ; Heung Sik KANG ; Jae Seung KIM ; Seon Kyu LEE ; Man Chung HAN ; Chu Wan KIM
Journal of the Korean Radiological Society 1993;29(3):516-521
To evaluate the usefulness of MR in the osteomyelitis, we reviewed MR examinations of 14 patients with pyogenic osteomyelitis of the long bone. All 14 patients were confirmed to have osteomyelitis either surgically (13/14) or by aspiration (1/14). MRI was performed with 0.5R (n=8) or 2.0T (n=6) SE technique, and Gd-DTPA enhanced T1WI was obtained in 10 examinations. Anatomic location of lesions were femur (8/14), tibia (5/14),m and fibula (1/14). The marrow cavity and soft tissue were involved in 13/14, 12/14 respectively. The signals of both intraosseous and extraosseous infected area were iso to low signal intensity to muscles on T1WI and high signal intensity on PDWI & T2WI. Rim or diffuse enhancement of the marrow cavity and soft tissue were seen in all (10/10) cases. Sequestra, periosteal reaction. And cortical defect were found in 12/14, 10/14, 9/14. MR provided more accurate and detailed anatomic information including extent of disease and possible activity than bone scintigraphy, CT, or conventional radiography. We conclude that MR might be the choice of modality in the diagnosis of osteomyelitis of the long bone.
Bone Marrow
;
Diagnosis
;
Femur
;
Fibula
;
Gadolinium DTPA
;
Humans
;
Magnetic Resonance Imaging
;
Muscles
;
Osteomyelitis*
;
Radiography
;
Radionuclide Imaging
;
Tibia
8.Acute Osteomyelitis in the Hand Due to Dog Bite Injury: A Report of 3 Cases.
Ryun LEE ; Hee Young LEE ; Ji Hyun KIM ; Yea Sik HAN ; Dong Chul KIM ; Kwan Chul TARK
Archives of Plastic Surgery 2017;44(5):444-448
As many people keep small dogs as pets, dog bites are common injuries, accounting for approximately 80%–90% of all animal bite injuries. These injuries usually occur on the upper extremities, most commonly on the fingers. Most of these injuries appear as simple lacerations or abrasions of the skin. Common symptoms include inflammatory reactions of the soft tissue, such as pain, swelling, erythema, and cellulitis. However, the complications of small dog bites may include joint or cartilage injuries, including acute osteomyelitis. Once osteomyelitis develops, it is difficult to diagnose since it has a latency period of approximately 2 weeks. Plain radiography, magnetic resonance imaging, and 3-phase bone scans should be performed when acute osteomyelitis is suspected, and broad-spectrum empiric antibiotic treatment should be administered for approximately 8–12 weeks. We report 3 very rare cases of acute osteomyelitis that occurred after a dog bite injury.
Animals
;
Cartilage
;
Cellulitis
;
Dogs*
;
Erythema
;
Fingers
;
Hand*
;
Joints
;
Lacerations
;
Latency Period (Psychology)
;
Magnetic Resonance Imaging
;
Osteomyelitis*
;
Radiography
;
Skin
;
Upper Extremity
9.Acute Osteomyelitis in the Hand Due to Dog Bite Injury: A Report of 3 Cases.
Ryun LEE ; Hee Young LEE ; Ji Hyun KIM ; Yea Sik HAN ; Dong Chul KIM ; Kwan Chul TARK
Archives of Plastic Surgery 2017;44(5):444-448
As many people keep small dogs as pets, dog bites are common injuries, accounting for approximately 80%–90% of all animal bite injuries. These injuries usually occur on the upper extremities, most commonly on the fingers. Most of these injuries appear as simple lacerations or abrasions of the skin. Common symptoms include inflammatory reactions of the soft tissue, such as pain, swelling, erythema, and cellulitis. However, the complications of small dog bites may include joint or cartilage injuries, including acute osteomyelitis. Once osteomyelitis develops, it is difficult to diagnose since it has a latency period of approximately 2 weeks. Plain radiography, magnetic resonance imaging, and 3-phase bone scans should be performed when acute osteomyelitis is suspected, and broad-spectrum empiric antibiotic treatment should be administered for approximately 8–12 weeks. We report 3 very rare cases of acute osteomyelitis that occurred after a dog bite injury.
Animals
;
Cartilage
;
Cellulitis
;
Dogs*
;
Erythema
;
Fingers
;
Hand*
;
Joints
;
Lacerations
;
Latency Period (Psychology)
;
Magnetic Resonance Imaging
;
Osteomyelitis*
;
Radiography
;
Skin
;
Upper Extremity
10.Vesicocutaneous Fistula Presenting Groin Abscess and Chronic Osteomyelitis in Pubic Bone.
Sang Bum KIM ; Woong Kyo JUNG ; Dong Ik SONG ; Soon Hyuck LEE
Clinics in Orthopedic Surgery 2009;1(3):176-179
The authors report a case of bladder fistula associated with a medial thigh cutaneous fistula and chronic osteomyelitis of the pubic bone 11 years after surgery for a pelvic bone fracture and bladder rupture. In the presenting case, despite the clinical suspicion, none of the diagnostic tools demonstrated the bladder fistula preoperatively. This case suggests that bladder repair should be prepared, even if the bladder fistula cannot be confirmed by imaging studies because the amount of urine leakage can be minimal or the fistula can close spontaneously.
Abscess/complications/*diagnosis
;
Cutaneous Fistula/complications/*diagnosis/radiography/surgery
;
Groin
;
Humans
;
Male
;
Middle Aged
;
Osteomyelitis/complications/*diagnosis/radiography
;
Pelvis/radiography
;
*Pubic Bone/surgery
;
Urinary Bladder Fistula/complications/*diagnosis/radiography/surgery