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Image Interp > Musculoskeletal Infection > Flashcards

Musculoskeletal Infection Flashcards

1
Q

What image modality is this and what condition do these findings demonstrate?

A

Sagittal MRI - Spondylitis Tuberculosis

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2
Q
  • Diffuse infection of a muscle or muscle group
  • Present with short history of fever and localized pain with passive movement of the muscle
  • Staphylococcus aureus is most common organism
  • Clostridial myonecrosis is an acute life-threatening form with surgical debridement often the only chance for survival
A

Pyomositis

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3
Q

What are the findings and differentials for this image?

A
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4
Q

What condition is shown here?

A

Cellulitis

(Soft tissue emphysema; could also be result of trauma)

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5
Q

Ultrasound, MRI and CT are useful in evaluation & differentiating with _____

A

Osteomyelitis

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6
Q

Suppurative Osteomyelitis in what age group?

  • More insidious onset
  • Local signs of inflammation, systemic signs of infection
  • Common organisms: Staph aureus, pseudomonas, Klebsiella)
A

Adult (16+)

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7
Q

What is likely cause of these findings?

A

Suppurative Osteomyelitis

(Involucrum, cortical destruction)

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8
Q

What are these findings associated with?

A

Pathologic fracture secondary to Suppurative Osteomyelitis

(posterior angulation of segment, increased soft tissues)

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9
Q

Infection of periosteum =

A

Periostitis

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10
Q

What modality is used in his image & what condition is demonstrated?

A

Ultrasound

Cellulitis

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11
Q

What are the findings and differentials for this image?

A
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12
Q

What is likely the cause of these findings?

A

Infectious Spondylitis (Suppurative)

(ill-defined endplates, periarticular osteopenia of endplates)

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13
Q

In _____, hemtogenous spread in long bones of suppurative osteomyelitis occurs when:

  • Vessels penetrate the closed growth plate
  • Epiphyseal & metaphyseal region can be involved, as well as joint
  • Joint involvement secondary to osteomyelitis is more common in this age group because of this
A

Adult (16+)

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14
Q
  • Solid infected and inflamed tissue with intact blood supply, may progress to abscess
  • MRI and or ultrasound can help differentiate with abscess
A

Phlegmon

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15
Q

Infection in a joint space =

A

Septic Arthritis

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16
Q
  • Result of subacute or chornic osteomyelitis
  • Sharply outline focus of burned out infection, may be sterile or contain residual Staph organism
  • See oval or serpiginous lucency greater than 1cm in diameter & a variable zone of surrounding reactive sclerosis
  • Likes distal tibia and knee
A

Brodies Abscess

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17
Q

Organisms causing septic arthritis enter in what means

A

Direct implantation

Hematogenous route

Extension from adjacent bone infection

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18
Q

What condition results in these findings?

A

Cellulitis

(Increased soft tissue, effusion, small vessel calcification; patient likely diabetic)

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19
Q

_____ is most common in lower extermity (hip & knee, spreads to these locations by traveling along psoas)

  • initial infetion starts in metaphysis then spreads to joint
  • Changes primarily joint related w/ adjacent bone destruction
  • May result in fibrous ankylosis
A

Tuberculous Arthritis

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20
Q

____ is most common level involved in infectious spondylitis - non-supurrative

A

L1

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21
Q

Subligamentous spread is more common and may lead to anterior vertebral body erosio, psoas (cold) abscess, additional joint involvement (most common joint affected = hip)

= what condition

A

Infectious Spondylitis - Non-Suppurative

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22
Q

What are the findings and differentials for this image?

A
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23
Q

Acute ____ will demonstrate rapid destruction of bone

  • 10 day laten period on x-ray
  • Permeative or moth-eaten pattern of bone destruction
  • Solid or laminated periosteal reaction
A

Suppurative Osteomyelitis

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24
Q

What is shown here?

A

Sacroilitis - Septic Arthritis

(Loss of joint space; monoarticular inflammatory arthritis → think infection)

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25
Q

What condition results in these findings?

A

Septic Arthritis

(Periarticular osteopenia, destruction of femoacetabular joint)

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26
Q

Suppurative Osteomyelitis in what age group?

  • Males most commonly affected
  • Acute onset of symptoms
  • Local signs of inflammation, systemic signs of infection
  • Common organisms: Staph aureus, salmonella
A

Childhood (1-16 yrs)

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27
Q

What imaging modality & condition is shown here?

A

Coronal MRI

Suppurative Osteomyelitis; abscess

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28
Q

This is an example of suppurative osteomyelitis via _____

A

Direct Implantation

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29
Q

What imaging modality & what condition is shown here?

A

MRI (T1 w/ contrast) - Suppurative Osteomyelitis

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30
Q
  • Rapidly destructive infection along fascial planes
  • Most often polymicrobial
  • Solitary infection with Group A Streptococcal and Clostridium species may also be responsible
  • Typically life-threatening requiring emergency surgery
  • Diabetics at particular risk owing to immunocompromised and vascular insufficiency
A

Necrotizing fasciitis

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31
Q

In adults, _____ will appear as:

  • Often wont show osseous changes until 21 days
  • Infection occurs at anterior corners of body & spreads to endplate → endplate irregularity/destruction, disc height loss
    • May see paraspinal line displacement from edema/abscess/phlegmon
  • May see epidural abscess causing cord compression
  • SI joint involvement presents as unilateral sacroilitis
A

Infectious Spondylitis (Suppurative)

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32
Q

This is an example of

A

Involucrum (Suppurative Osteomyelitis)

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33
Q

What is this photo demonstrating?

A

Septic Arthritis

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34
Q

What region of the spine is most likely to be affected by infectious spondylitis (aka spondylodiskitis)

A

Lumbar

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35
Q
  • Living bone (periosteal reaction) that forms around necrotic bone (sequestrum) and attems to wall off the infection
  • Seen in Suppurative Osteomyelitis
A

Involucrum

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36
Q

This is an example of what condition

A

Suppurative Osteomyelitis (Direct implantation or post-op)

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37
Q

Most common route of spread in Suppurative Osteomyelitis is _____ but can also be contiguous (direct spread from another site of infection), direct implantation or post-op

A

Hematogenous

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38
Q
  • Infection centered along fascial planes
  • Serious condition often requiring surgical debridement
A

Fasciitis

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39
Q

Infection of the cortex =

A

Osteitis

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40
Q

What is likely the cause of these findings?

A

Suppurative Osteomyelitis (Permeative/motheaten)

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41
Q
  • Acute inflammatory response due to infection of the cutaneous and subcutaneous tissues
  • Most commonly due to Staphylococcus aureus and less commonly Streptococcus pyogenes
  • Usual route of infection is direct implantation
A

Cellulitis

42
Q

Infection of bone marrow =

A

Osteomyelitis

43
Q

The following radiographic changes are associated with _____:

  • Soft tissue changes within 3 days of bone infection
  • Localized swlling & fat plane displacement
  • Blurring of fat/muscle interface
  • May see soft tissue emphysema (gas)
  • Phlegmon, soft tissue abscess
  • Sinus tracts (hole in tissues)
A

Suppurative Osteomyelitis

44
Q

What are the findings and differentials for this image?

A
45
Q

What are the findings and differentials for this image?

A
46
Q

What are the findings and diagnosis for this image?

A
47
Q

What are the findings and diagnosis for this image?

A
48
Q
  • Can occur as a result of a variety of soft tissue infections
  • Staphylococcus aureus is most common organism
  • Can mimic necrotic tumors on imaging
A

Abcess

49
Q

This is demonstrating the progression of

A

Suppurative Osteomyelitis

(Sequestrum in 5 months)

50
Q

What are the findings and differentials for this image?

A
51
Q

Phemister’s triad consists of:

  • Juxta-articular osteoporosis
  • Articular erosions
  • The key is maintained joint space until late in the disease process

This is associated with _____

A

Tuberculous Arthritis

52
Q

What condition would result in these findings?

A

Tuberculous Arthritis

(Marginal erosion, juxta-articular osteopenia)

53
Q

Joint aspiration & culture is needed for definitive diagnosis of _____

A

Septic Arthritis

54
Q

What are the findings and differentials for this image?

A
55
Q

What is shown here?

A

Sequestration (Suppurative Osteomyelitis)

(CT on right)

56
Q

In this Axial CT of cervical spine, what is demonstrated?

A

Sequestration (Suppurative Osteomyelitis)

57
Q

What are the findings and differentials for this image?

A
58
Q

What type of study is shown here?

A

Coronal CT

59
Q

In _____, hemtogenous spread in long bones of suppurative osteomyelitis occurs when:

  • Vessels perforate open growth plate
  • Epiphysis or metaphysis can be affected, as well as joint
A

Infantile (0-1 years)

60
Q

What is the likely cause of these findings?

A

Infectious Spondylitis (Suppurative) - with increased retrotracheal space

(complete loss of disc height w/ endplate destruction, gapping of facet joint/widening of interspinous face, calcifications on anterior)

61
Q

What are the findings and differentials for this image?

A
62
Q

What are the findings and differentials for this image?

A
63
Q

What is likely the cause of these findings?

A

Infectious Spondylitis (Suppurative) - Deviated paraspinal lines

(Could also be a result of trauma, tumor, etc.)

64
Q

What are the findings and differentials for this image?

A
65
Q
  • Usually due to tuberculosis or less often fungal infections
  • Less common
  • Course is insidious
  • Insidious back pain, decreased motion & tenderness in spine
  • Joint swelling, increased temp, muscle atrophy seen in extremities
A

Infectious Spondylitis - Non-Suppurative

66
Q

What are the findings and differentials for this image?

A
67
Q
  • Cortical and/or periosteal defect which allows draining of pus out of bone
  • Seen in Suppurative Osteomyelitis
A

Cloaca

68
Q

What are the findings and diagnosis for this image?

A
69
Q

What is a definitive diagnosis based on these findings?

A

Tuberculosis Spondylitis

(Tear-drop shaped cold abscesses)

70
Q

Changes in ____ occur rapidly compared to other inflammatory arthritis

  • Distension of capsule
  • Widening of joint space early on, loss of space in a few weeks
A

Septic Arthritis

71
Q

In _____, hemtogenous spread in long bones of suppurative osteomyelitis occurs when:

  • Metaphysis is most common site of origin
  • Vessels dont penetrate growth plate and blood flow is sluggish
A

Childhood (1-16 yrs)

72
Q

Bacterial Osteomyelitis = ____ osteomyelitis

Tuberculosis or Fungal infections = ____ osteomyelitis

A

Suppurative

Nonsuppurative

73
Q

Suppurative Osteomyelitis in what age group?

  • Commonly multi-focal
  • Pain & swelling in region of infection
  • Unwilling to move affected bone
  • Common organisms: Strep Group B, Staph aureus, E. coli
A

Infantile (0-1 yrs)

74
Q

What are the findings and differentials for this image?

A
75
Q

What is shown here?

A

Septic Arthritis

76
Q

What is shown here?

A

Brodies Abscess

77
Q
A

Cloaca (Suppurative Osteomyelitis)

(Irregular cortical thickening & trabeculae patterns, lucent channel that goes into round defined lucency)

78
Q

What deformity is this and what condition is it associated with?

A

Gibbus - associated with Tuberculosis Spondylitis (but can occur with other conditions)

79
Q

What is shown here?

A

Cloaca in an involucrum (suppurative osteomyelitis)

80
Q

What modality & condition is demonstrated here?

A

Sagittal MRI of CS/TS spine

Infectious Spondylitis (Suppurative)

81
Q

What is likely the cause of these findings?

A

Tuberculosis Spondylitis (cannot neccessarily differentiate from other infection w/o hx)

Differentiate between suppurative vs. non-suppurative you need clinical hx

82
Q

What condition is likely shown here?

A

Suppurative Osteomyelitis

83
Q

_____ is the most common organism that causes septic arthritis

_____ is more common in IV drug users

A

Staph Aureus

Pseudomonas aeruginosa

84
Q

Clinical prevention of _____ includes:

  • Redness and swelling of the affect limb with pain
  • Fever and general systemic feeling of unwellness are common
  • Spread in a progressive fashion possibly resulting in redlines following the lymphatic tracks
A

Cellulitis

85
Q

_____ is most common organism to cause infections spondylitis - suppurative

A

Staph aureus

86
Q

In children, ______ will show up as:

  • Loss of disc height
  • Secondary endplate & vertebral body destruction
  • May see paraspinal line displacement from edema/abscess/phlegmon
A

Infectious spondylitis (suppurative)

87
Q

What are the differentials & treatment for Brodies Abscess?

A

Osteoid osteoma, osteoblastoma

Surgical decompression & curettage

88
Q

This is demonstrating a treatment for what condition?

A

Suppurative Osteomyelitis - Antibiotic beads

89
Q

______ is more common in skeletal immature individuals in appendicular skeleton (lower extremity, femur & tibia most commonly affected)

  • Males: Females = 3:1
  • Peak age range = 2-12 years
  • 90% due to staph aureus
A

Suppurative osteomyelitis

90
Q

Tuberculosis spondylitis is going to result in _____ deformity eventually

A

Kyphotic

91
Q

Radiologic findings of ____ include:

  • Periarticular osteopenia
  • Erosions
  • Subchondral bone destruction
  • Osseous ankylosis of affect joint late (rare)
A

Septic Arthritis

92
Q
  • Fragment of infected necrotic bone, no blood supply
  • Forms in chronic osteomyelitis
A

Sequestrum

93
Q

What are the findings and differentials for this image?

A
94
Q

What condition is shown here?

A

Septic Arthritis

(increased soft tissue size & erosions of joint)

95
Q

Clinical features of ____ include:

  • Decreased ROM due to pain and capsular edema
  • May see fever, chills, erythema
  • Labs show elevated ESR, leukocytes & positive culture
A

Septic Arthritis

96
Q

What is likely the cause of these findings?

A

Suppurative Osteomyelitis

(Permeative/motheaten, possible cortical destruction, laminated/solid periosteal reaction)

97
Q

What are the findings and differentials for this image?

A
98
Q

What are the findings and differentials for this image?

A
99
Q

What modality of imaging & what condition is shown here?

A

Coronal CT

Suppurative Osteomyelitis w/ sequestrum

100
Q

What are the findings and diagnosis for this image?

A

Image Interp (11 decks)

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