Diagnosis and treatment of emphysematous osteomyelitis
10.3760/cma.j.cn121113-20240624-00367
- VernacularTitle:气肿性骨髓炎的影像学特征、诊断及治疗
- Author:
Na ZHAO
1
;
Liyuan XIE
;
Jicun LIU
;
Wenjuan WU
;
Guifen HAN
Author Information
1. 河北省直属机关第一门诊部放射科，石家庄 050001
- Publication Type:Journal Article
- Keywords:
Osteomyelitis;
Tomography, spiral computed;
Magnetic resonance imaging;
Case reports;
Bone gas
- From:
Chinese Journal of Orthopaedics
2025;45(4):241-245
- CountryChina
- Language:Chinese
-
Abstract:
A retrospective analysis was conducted on data from five patients comprehensively diagnosed with emphysematous osteomyelitis (EO) based on clinical, imaging, microbiological culture, and surgical findings at Hebei Medical University Third Hospital from December 2020 to May 2024. Among these five cases, there were three males and two females, aged between 11 and 69 years. Three patients had infection risk factors (two with diabetes and one with anemia), while two had no documented risk factors in their medical history. All patients presented with fever, localized pain at the infection site, and elevated inflammatory markers. Site of incidence: EO affected the lumbar spine in three cases, the ilium in one case, and the femur in one case. Pathogenic microorganisms: The causative agents included Klebsiella pneumoniae (two cases), Escherichia coli (one case), Burkholderia cepacia (one case), and a mixed infection of Staphylococcus aureus and Acinetobacter baumannii (one case). Imaging findings: Among the three patients who underwent X-ray examinations, one showed normal results, while two exhibited bone destruction. CT scans of all five cases revealed the characteristic "pumice sign" without periosteal reaction or osteosclerosis. MRI, performed on four patients, demonstrated bone destruction, swelling of surrounding soft tissues, and soft tissue abscess formation. Treatment and outcomes: Four patients underwent surgical debridement combined with perioperative antibiotic therapy. Of these, three recovered well, while one achieved good infection control but suffered severe joint destruction. One patient died after treatment was discontinued. The clinical and laboratory findings of EO resemble those of common acute osteomyelitis; however, EO has distinct imaging characteristics. Timely diagnosis, aggressive surgical debridement, and strong, targeted antibiotic therapy can result in favorable outcomes. Conversely, delayed diagnosis and treatment may lead to severe complications or death.
