EURORAD ESR

Case 14631

Pyomyositis in a child

Author(s)
Gisela Rio1, Carlos André Oliveira1, Marta Reis Sousa2, Pedro da Silva Oliveira1

1Braga Hospital
2Entre Douro e Vouga Hospital
 
Patient
male, 7 year(s)
 
 
  • Figure 1
    Left leg radiography

    AP (A) and lateral (B) radiographs of the left leg don't show any abnormality.

     
    Area of Interest: Musculoskeletal soft tissue; Imaging Technique: Conventional radiography; Procedure: Education; Special Focus: Infection;
     
     
  • Figure 2
    Ultrasound
     

    Ultrasound (a, b) revealed enlargement and heterogeneity of the deeper muscles which are in contact with the peroneal diaphysis. There were no obvious collections suggesting haematomas or abscesses.

     
    Area of Interest: Musculoskeletal soft tissue; Imaging Technique: Ultrasound; Procedure: Education; Special Focus: Infection;

    Ultrasound (a, b) revealed enlargement and heterogeneity of the solear muscle contacting the peroneal diaphysis. There were no obvious collections suggesting haematomas or abscesses.

     
    Area of Interest: Musculoskeletal soft tissue; Imaging Technique: Ultrasound; Procedure: Education; Special Focus: Infection;
     
     
  • Figure 3
    Left leg MRI
     

    Sagittal T2-WI MRI revealing a hyperintense mass around the peroneal bone (arrowheads). Note the diffuse high signal intensity of the tissues surrounding the collection.

     
    Area of Interest: Musculoskeletal soft tissue; Imaging Technique: MR; Procedure: Education; Special Focus: Infection;

    Axial T2-SPIR confirms the presence of a fluid collection involving the flexor hallucis longus, tibial posterior and solear muscles (arrowheads). Note the hyperintensity of the surrounding muscles due to reactive oedema.

     
    Area of Interest: Musculoskeletal soft tissue; Imaging Technique: MR; Procedure: Education; Special Focus: Infection;
     
     
  • Figure 4
    MRI after gadolinium
     

    Sagittal (4a), coronal (4b) and axial (4c) T1FS post-gadolinium demonstrates a central hypointensity surrounded by a hyperenhancing rim, confirming the presence of an abscess.

     
    Area of Interest: Musculoskeletal soft tissue; Imaging Technique: MR; Procedure: Education; Special Focus: Infection;

    Coronal T1FS post-gadolinium showing the thick enhancing walls of the abscess. There is also subcutaneous, fascial, and muscular inflammation, as well as osseus enhancement concerning the fibula.

     
    Area of Interest: Musculoskeletal soft tissue; Imaging Technique: MR; Procedure: Education; Special Focus: Infection;

    Axial T1FS post-gadolinium showing the deep relation of the abcess with the fibula as well as the surrounding muscle enhancement due to inflammation.

     
    Area of Interest: Musculoskeletal soft tissue; Imaging Technique: MR; Procedure: Education; Special Focus: Infection;
     
     
  • Figure 5
    MRI after 3 months

    PD-SPAIR MRI after 3 months of antibiotherapy reveals disappearance of the abscess and marked decrease of the oedema involving the referred muscles, showing only slight remaining oedema in the proximal fibula (arrow).

     
    Area of Interest: Musculoskeletal soft tissue; Imaging Technique: MR; Procedure: Education; Special Focus: Infection;
     
     
AP (A) and lateral (B) radiographs of the left leg don't show any abnormality.
 
Ultrasound (a, b) revealed enlargement and heterogeneity of the deeper muscles which are in contact with the peroneal diaphysis. There were no obvious collections suggesting haematomas or abscesses.
 
Ultrasound (a, b) revealed enlargement and heterogeneity of the solear muscle contacting the peroneal diaphysis. There were no obvious collections suggesting haematomas or abscesses.
 
Sagittal T2-WI MRI revealing a hyperintense mass around the peroneal bone (arrowheads). Note the diffuse high signal intensity of the tissues surrounding the collection.
 
Axial T2-SPIR confirms the presence of a fluid collection involving the flexor hallucis longus, tibial posterior and solear muscles (arrowheads). Note the hyperintensity of the surrounding muscles due to reactive oedema.
 
Sagittal (4a), coronal (4b) and axial (4c) T1FS post-gadolinium demonstrates a central hypointensity surrounded by a hyperenhancing rim, confirming the presence of an abscess.
 
Coronal T1FS post-gadolinium showing the thick enhancing walls of the abscess. There is also subcutaneous, fascial, and muscular inflammation, as well as osseus enhancement concerning the fibula.
 
Axial T1FS post-gadolinium showing the deep relation of the abcess with the fibula as well as the surrounding muscle enhancement due to inflammation.
 
PD-SPAIR MRI after 3 months of antibiotherapy reveals disappearance of the abscess and marked decrease of the oedema involving the referred muscles, showing only slight remaining oedema in the proximal fibula (arrow).
 
 
 
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