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Infections Flashcards

1
Q

What is cellulitis?

A

infection of skin, subcutaneous fat, or connective tissue such as tendons/ligaments/muscle

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2
Q

What is osteomyelitis?

A

Infection of bone

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3
Q

What is septic arthritis?

A

infection of joint (synovial tissue/articular surfaces)

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4
Q

What are the at risk groups for infections?

A
  1. Immunosuppressed
  2. Diabetes
  3. Post-surgical
  4. Vascular insufficiency
  5. Sickle cell anemia
  6. IV drug users
  7. When conditions are right
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5
Q

What joints are drug addicts usually prone to infection in?

A

ā€œSā€ Joints - spine, sacroiliacs, symphysis pubis, sternoclavicular

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6
Q

What is the most common organism for infection?

A

Staph aureus (90%)

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7
Q

What are the modes of infection?

A
  1. Trauma/post surgical
  2. Urinary tract infection
  3. Pneumonia
  4. Skin infections
  5. Open wound or cellulitis
  6. Heel sticks in infants
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8
Q

What are the route of dissemination of infection?

A
  1. Hematogenous
  2. Direct extension
  3. Direct implantation
  4. Postoperative
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9
Q

What is the most common route of dissemination of infection?

A

Hematogenous

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10
Q

What is the infantile pattern of vascular anatomy?

A

metaphyseal and diaphysral vessels may penetrate the physics (septic arthritis and osteomyelitis)

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11
Q

What is the childhood pattern of vascular anatomy?

A

1 year to physis closure, metaphyseal blood flow is slow and turbulent, metaphyseal vessels do not penetrate physics, separate epiphysis blood supply (tends to spare epiphysis and joint)

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12
Q

What is the adult pattern of vascular anatomy?

A

metaphyseal vessel penetrate the vanishing physics, establishing communication with the subarticular bone end (osteomyelitis and septic arthritis)

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13
Q

What are the most common locations for infections?

A 
Knee
Hip
Ankle (distal tibia)
Shoulder
Spine
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14
Q

What are the two major categories for infections?

A

Suppurative (pus)

Non-suppurative (TB)

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15
Q

What is suppurative osteomyelitis?

A

Bone marrow infection by (pyogenic) non-tubular organism (anything but TB)

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16
Q

What is the most common suppurative organism of infection?

A

Staph. aureus

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17
Q

What are the clinical features of acute infection?

A

Edmea, lymphadenopathy, warm skin, cellulitis, joint pain

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18
Q

What are the 4 radiographic stages of infection?

A
  1. Latent/Hidden
  2. Early
  3. Middle
  4. Late
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19
Q

How long is the hidden/latent stage of infection?

A

1 to 10 days

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20
Q

How long is the early stage of infection?

A

10-21 days

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21
Q

How long is the middle stage of infection?

A

weeks

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22
Q

How long is the late stage of infection?

A

months

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23
Q

What radiographic features may be present during the early stage of infection

A

Soft tissue edema and osteopenia (micro holes). Edema displaces lucent fat planes and tends to obliterate soft tissue margins and become mass like

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24
Q

How long is the early stage of infection of spinal lesions?

A

3 weeks

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25
What radiographic features may be present during the middle stage of infection?
Permeative or lytic moth-eaten destruction (may cross anatomical barriers), periosteal response, solid, codman's triangle, laminated
26
What can the middle stage of infection look similar to?
Ewing sarcoma
27
What radiographic features may be present during the late stage of infection?
``` Cortical destruction Draining sinus Involucrum - bony collar Cloaca - big open sore Sequestrum - piece of dead bone inside bone Sclerosis Debris Loss of joint space - both sides Ankylosis Chronic incomplete resolution Immune deficient ```
28
What is a sequestrum?
Chalky, white area representing isolated dead bone and cortical and medullar infarcts
29
What can a sequestrum of infection look similar to?
Osteoid osteoma
30
What difference would there be between osteoid osteoma and sequestrum of infection?
Pain would be worse at night with osteoid osteoma and there would be a fever with infection
31
What is an involucrum of infection?
"bony collar" - chronic periosteal response, pus lifts the periosteum and causes new bone formation, trying to wall off the infection
32
What is the body's attempt to wall things off during the late stages of infection?
Involucrum
33
What is a cloaca?
Ulcerative channel from bone to outside
34
What is Marjolin's ulcer?
A rare complication of infection that is squamous cell carcinoma within the channel of cloaca
35
What stage of infection is cloaca associated with?
Late stage
36
What is a Brodie's abscess formation?
Localized, aborted form of suppurative osteomyelitis
37
What does a Brodie's abscess formation look similar to?
Giant cell tumor
38
What are the symptoms of a Brodie's abscess formation?
Localized pain, worse at night relieved by aspirin
39
What symptoms of a Brodie's abscess formation mimic?
Osteoid osteoma
40
What location is a Brodie's abscess formation commonly found in?
Metaphyseal region, MC distal tibia (ankle)
41
What does a Brodie's abscess formation look like?
Oval, elliptical or serpiginous (worm like) radiolucency with heavy reactive sclerosis
42
What are the differences between a tumor and infection?
Tumor respects growth plates and deflects fascial planes while infection has no respect for growth plate or joint spaces
43
What are features of septic arthritis?
Joint effusion, juxtaarticular osteoporosis, erosions, joint space loss, lytic destruction that crosses joint space
44
What is one sign of infection in the hip?
Increased teardrop distance
45
What distance is important regarding teardrop distance?
Greater than 11 mm or 2 mm difference from the opposite joint
46
What are the fat planes of the hip?
Gluteus medius, obturator internus and iliopsoas
47
Until what age is the intervertebral disc is still vascular?
20 years of age
48
How does infection spread in someone under age 20 if it is in the spine?
Infection starts in disc then spreads to adjacent bodies/endplates
49
How does infection spread in adults if it is in the spine?
Starts in anterior vertebral endplates then does to the disc with vertebral collapse and soft tissue paraspinal mass
50
What is the most common location for infection in the spine?
Lumbar spine
51
What is the most common location for infection in the spine in IV drug users?
Sacroiliac joints
52
How is infection in the spine spread?
Batson's Venous Plexus
53
What are early radiographic features of infection in the spine?
Rapid disc space loss and endplate destruction
54
What are the limitations of plain films in regards to infection?
Not really a sensitive exam, must have significant loss in bone density before it is detected, other imaging studies are better for detection of early infection
55
Why is bone scintigraphy better for infection detection?
Maybe positive within hours, gallium for RBC, Indium for WBCs, very sensitive, often followed by MRI for evaluation of soft tissue
56
What are the advantages of CT in infection?
See findings earlier than plain films, good for hard to image areas (spine, pelvis, sternum), findings are more specific and suggestive of osteomyelitis (increase marrow density, demineralization, periosteal reaction)
57
What is another name for non-suppurative osteomyelitis?
TB
58
What is Pott's Disease?
TB in the spine
59
What is referred to as the king of disease?
TB
60
What is the most common cause of infection related death worldwide?
TB
61
What is the most common secondary form of TB?
Skeletal involvement of TB
62
What is the most common location of TB in the spine?
Thoracolumbar junction
63
Where does TB like to spread under in the spine?
ALL
64
Where does TB infection typically start in the spine?
Anterior endplate region
65
What is the earliest radiographic finding of TB in the spine?
Disc space narrowing
66
What is a common result of TB in the spine?
Vertebral body collapse
67
What does TB look like on MRI?
Decreased T1 and increased T2
68
What percentage of TB skin tests are positive?
90-100%
69
What percentage of chest films are positive for granulomas?
50%
70
What are some clinical signs of TB?
Unexplained weight loss, fever, chills, night sweats, tenderness in the involved bones and joints
71
What is Gibbous formation?
Acute kyphotic angular deformity in the spine in a patient with TB
72
What is the Phemister's Triad?
Tuberculosis septic arthritis - juxtarticular osteoporosis, marginal erosions (both sides of joint), slow joint space loss
73
What are treatment options for TB?
Chemo, debridement, arthrodesis, surgical
74
Which has a slower progression of joint destruction? Suppurative vs TB?
TB
75
Which has a slower response to therapy? Suppurative or TB?
TB

Di Imaging 2 (3 decks)

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