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Radiology > Osseous Infection > Flashcards

Osseous Infection Flashcards

1
Q

Common sites of infection in…

  • Infants
  • Adults
  • IV drug users/TB
A

Infants - Appendicular
Adults - Axial
IV drug users - Spinal and S-joints

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2
Q

What is Garre Sclerosing osteomyelitis

A

Sclerotic, non-purulent OM form

Reserved term for protuberant periosteal reaction with osseous deposition and no necrosis and little granulation tissue

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3
Q 
Common infectious pathogens by age
Neonate
1-4 YO
4-18 YO
18+ YO
A

Neonate - S. Aureus, Group B strep, E. Coli
1-4 YO - S. Aureus, S. Pyogenes, H. influenza
4-18 YO - S. Aureus
18+ YO - Gram negative bacteria, S. Aureus

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4
Q

3 Common locations from which contiguous spread can occur

A

Cutaneous
Sinus
Dental

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5
Q

Contiguous spread in hands is MC how?

A

VIA the tendon sheaths

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6
Q

Direct implantation infection fact from animal bites

A

90% of bites are Dog

10% are cats, More common to lead to infection from Pasteurella multicoida

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7
Q

Brodie Abscess

A

Intraosseous abscess (subacute or chronic OM)
Found in kids (look for open growth plates)
Likes to affect young boys in the metaphysis
-Diaphysis is more cortically based
-Epiphysis is lytic, circular destruction

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8
Q

Complications of osteomyelitis

A

Severe osteolysis
Epiphyseal growth changes
Neoplasm - Epidermoid carcinoma
Secondary amyloidosis

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9
Q

Pathogens for septic arthritis

A

S. Aureus is MC

H. influenza in <5YO

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10
Q

Rad features of septic arthritis

A

interosseous space is initially increased and then decreased, joint distention/ST effusion, destruction of the osseous plate from pannus, can see gas formation, endstage is osseous ankylosis
 Rapid destruction of bone and joint is seen with pyogenic infection, where as slow joint changes is seen with TB and fungal infections

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11
Q

Contiguous spread sites into the joint in Septic Arthritis

A

Direct extension from epiphysis
Infants and adults can have infection extend from diaphysis into the epiphysis
Infection can spread laterally from the metaphysis into the joint capsule

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12
Q

Good differential diagnosis for septic arthritis

A

PVNS, SCM/SOC, JCA, RA and gout

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13
Q

Where is septic subcutaneous bursitis found

A

Olecranon and prepatellar bursa

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14
Q

Cellulitis (pathogen and rad)

A

 Acute inflammatory process of deeper subcutaneous tissue
 MCly seen with strep infection and less commonly staph infection
 MR T2 shows subcutaneous thickening and hyperintense streaks with T1+C enhancement
 Can be accompanied by lymphadenitis

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15
Q

Endemic and pathogen of infectious myositis

A

Seen in kids and young adults in tropical areas

S. Aureus is MC

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16
Q

Chronic granulomatous disease

A

 Purulent granulomatous/eczematoid skin lesions, hepatosplenomegaly, pneumonias and chronic OM
 Seen more in Males
 Specific condition known as Rhinoscleroma caused by Klebsiella rhinoscleromatis

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17
Q

Chronic recurrent multifocal osteomyelitis

A

 Idiopathic, inflammatory bone disorder seen in females, kids/young adults
 Dx of exlusion
 Fever, multifocal bone pain, weightloss
 Likes the metaphysis and tibia
 Starts off as lytic and then becomes sclerosing
 DDx: Garre, Ewing, LCH,, infectious OM

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18
Q

MC pathogen is opioid abusers

A

Candida in the oropharynx and skin

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19
Q

Spinal infections facts

A

MC in 40-60 YO males
Fever, malaise, weightloss, back pain
<20 - can spread disc to VB
>20 - spreads VB to disc

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20
Q

Grisel syndrome

A

Torticollis, neck pain from C1/2 subluxation from inflammatory laxity usually after a retropharyngeal infection

Caused by S. Aureus, group B Strep and oral flora

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21
Q

When is osteomyelitis hot on bone scan

A

Hot in all 3 phases

22
Q

Infective spread between pyogenic spondylitis vs TB spondylitis

A

Pyogenic - Spreads VIA arterial supply entering metaphyses and endplates and spreads VIA the disc

TB - Spreads VIA venous supply with primary involvement of the anterior corners of the VB and then go under the ALL… likes to spare the disc until late disease

23
Q

Waterhouse-Friderichsen syndrome

A

Adrenal insufficiency from atrumatic/infective hemorrhage

can be caused by:

  • N. meningitidis
  • H. influenza
  • P. aerusginosa
  • E. coli
  • S. pneumoniae
24
Q

Gonococcal infection

A

Spreads from mucosal membranes from STDs or vaginal birth

Affects the knees, ankles, wrists, shoulders, foot and spine

25
Q

Emphysematous septic arthritis

A

Klebsiella pneumoniae

26
Q

Pseudomonas

A

Premature infants
IV drug users
Immunocompromised patients

Likes the S- joints

27
Q

Brucella

A

Endemic to Saudi Arabia, S. America, spain, Italy and midwest
from contaminated milk
Localizes to liver, spleen , lymph nodes and bone marrow

28
Q

Syphilis (general)

A

 T. pallidum from STD or intrauterine transmission
 Can be primary with Chancre formation, secondary with multisystem changes (derm, GI, MSK, renal and neuro) or tertiary with late neuro, cardiovascular and gummatous syphilis
 Hutchinson triad, sabre shin, saddle nose, desquamative rash

29
Q

Congenital Syphilis

A

Multisystem impact on infant
Early - Inflammed umbilical cord, hepatosplenomegaly, neurosyphilis, maculopapular rash
Late - Craniofacial (saddle nose, frontal bossing, prognathism), Hutchinson triad (teeth, eyes, nerve deafness), Wimberger sign (medial proximal tibial metaphysis erosions)

30
Q

Yaws (general)

A

Treponema pertenue
In tropical climate regions
Acquired in puberty from open would
results in periostitis and osteitis in extremities, calvarium and face

31
Q

Lyme disease

A

Borellia Burgdorferi
In the northeast, upper midwest and far west USA
ST swelling/effusion about the knee with osteopenia, cartilage loss and marginal erosions

32
Q

Common sites of TB infection

A

Lungs
Spine
Big joints (hips, knees and elbows)
Fingers

33
Q

What is Phemister’s triad

A
  • Juxta-articular osteoporosis
  • Peripheral osseous erosions
  • Gradual interosseous space narrowing
34
Q

Actinomycois

A
  • Infection of the face and head with trauma
  • likes the mandible, flat bones and major appendicular joints
  • Paraspinal abscesses, but non-calcific and smaller than TB
35
Q

Cryptococcus (Torulosis)

A
  • Ass’d with leukemia, lymphoma, HD, sarcoidosis, TB and DM

- Osseous involvement at the spine, pelvis, ribs, skull, tibia and femur

36
Q

North American Blastomycosis

A

Found in Ohio and Mississippi river
B. dermatitidis
Affects vertebra, ribs, tibia, carpla/tarsals

37
Q

South American Blastomycosis

A

B brasiliensis seen in S. America, Mexico and central america

38
Q

Coccidiomycosis

A

Found in SW USA, mexico and S. America

39
Q

Histoplasmosis

A

Mid-west, H capsulatum

Children> Adults

40
Q

Spirotrichosis

A

Fungal infection with skin and subQ lesions
Affects liver, spleen and lymph nodes
Likes the knees, wrists, hands, ankle, elbow and MCP

41
Q

Candidiasis

A

Hematogenous or direct extension

Likes to affect single long bone, sternum or consecutive vertebra

42
Q

Maduromycosis

A

Chronic granulomatous infection, likes the feet

Rad: melting snow sign, ST contamination, sinus tracks

43
Q

Rubella

A

Benign in adults, maternal transmission can lead to skeletal and non-skeltal alterations
o Postnatal Rubella
 Skin rash within days, articular symptoms in hands and wrists
 Live, attenuated vaccines implicated in arthropathy
• Catcher crouch syndrome  knee stiffness
 Intra-articular bone erosions
 DDx: JCA
o Intrauterine Rubella
 Symmetrical, linear radiolucency with increased bone density longitudinal (celery-stalk appearance)
• Disappears with recovery
• Healing reveals beak-like exostoses in the metaphysis

44
Q

HIV

A

o Rheumatologic disorders
 Falls within the spectrum of spondyloarthropathy
 Fasciitis and enthesopathy with marked muscle wasting without conjunctivitis  AIDS foot
o Infectious disorders
 Affects the knees, AC, SC and SI
 S. aureus and S. pneumoniae are implicated as opportunistic
 Pyomyositis found in Africa, SE Asia and S. America
• Multiple abscesses seen in 50%
o Kaposi Sarcoma
 Increased rates of lymphoma, HD and Kaposi sarcoma
 Arise of lymphatic endothelial cells and seen in 15-20% with HIV
• Bacillary Angiomatosis

45
Q

Rickettial infection (cat-scratch)

A

Bartonella henselae and Afipia felia

ST-based infection

46
Q

Loiasis

A

Loa Loa
West and central Africa
Rad: fine, coiled, lace-like, filamentous calcification, but can be thicker

47
Q

Filariasis

A

Asia, Africa, South America, Australia and the South Pacific islands
Rad: affected limbs are greatly enlarged with soft tissue thickening, blurring of subcutaneous fat planes and linear striated pattern, soft tissue calcifications containing calcified, dead filariae

48
Q

Trichinosis

A

Infected pork by T. spiralis

Cyst calcification

49
Q

Cysticercosis

A

Infected pork by T. solium

Rad: Oval ST calcification in the ST

50
Q

Echinococcus

A

Sheep and Cattle farmers
Cysts in the lungs, liver and can calcify
Rad: Osseous involvement is 1-2%
• Single/multiple expansile, cystic, osteolytic lesions that can violate the cortex
• DDx: fibrous dysplasia, plasmacytoma, GCT, skeletal metastasis, hyperparathyroidism
 CT: ST mass adjacent to bone with fluid attenuation
 MR: can be variable with intact, ruptured, infected cysts, T2WI is characteristic

51
Q

Ainhum (Dactylolysis spontanea)

A

Self-limiting in Blacks, pinky toe

52
Q

Tietze syndrome

A

Benign, self limiting

Rad: Occult on XR, may see ST swelling and calcifications, osteophyte and periostitis

Radiology (14 decks)

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