EURORAD ESR

Case 15211

Osteomyelitis pubis with bilateral muscle abscesses

Author(s)
Aliaksandr Anisau 1, 2
Filip M. Vanhoenacker 1, 2, 3

1. General Hospital AZ Sint-Maarten Duffel-Mechelen, Leopoldstraat 2, B-2800 Mechelen, Belgium.
2. University Ghent, Department of Medicine and Health Sciences.
3. University Hospital Antwerp, University Antwerp, Department of Radiology, University Hospital Antwerp; Wilrijkstraat, 10, 2650 Antwerp, Belgium; Email:filip.vanhoenacker@telenet.be
 
Patient
male, 55 year(s)
 
 
  • Figure 1
    Pelvic radiograph
     

    Widening of the symphysis (red circle).

     
    Area of Interest: Musculoskeletal bone; Musculoskeletal joint; Imaging Technique: Conventional radiography; Procedure: Diagnostic procedure; Special Focus: Arthritides;

    Erosions in both pubic bones, larger at the left side (red arrows).

     
    Area of Interest: Musculoskeletal bone; Musculoskeletal joint; Imaging Technique: Conventional radiography; Procedure: Diagnostic procedure; Special Focus: Arthritides;
     
     
  • Figure 2
    Contrast-enhanced CT of the pelvis
     

    Widening of the symphysis. Subchondral erosion in the left pubic ramus (pink arrow).

     
    Area of Interest: Musculoskeletal bone; Musculoskeletal joint; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Arthritides;

    Widening of the symphysis. Subchondral erosion in the left pubic ramus (pink arrow).

     
    Area of Interest: Musculoskeletal bone; Musculoskeletal joint; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Arthritides;

    Widening of the symphysis. Intra-articular collection extending anteriorly into the soft tissues, with subtle enhancement at the margins of the collection (orange arrow).

     
    Area of Interest: Musculoskeletal bone; Musculoskeletal joint; Musculoskeletal soft tissue; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Abscess; Arthritides; Infection;

    Bilateral collections along the adductor muscles with butterfly morphology and subtle rim enhancement (orange arrows).

     
    Area of Interest: Musculoskeletal bone; Musculoskeletal joint; Musculoskeletal soft tissue; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Abscess; Arthritides; Infection;
     
     
  • Figure 3
    MRI of the pelvis
     

    T1. Widening of the symphysis. Low T1 signal intensity in the pubic rami (red arrows) representing bone marrow oedema surrounding the erosions. Soft tissue extension along the adductor muscles (purple arrows).

     
    Area of Interest: Musculoskeletal bone; Musculoskeletal joint; Musculoskeletal soft tissue; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Abscess; Arthritides; Infection;

    T2 PD, TSE, fs. Widening of the symphysis. Bone marrow oedema in the pubic rami (red arrows). Pus in the symphysis pubis, extending along the adductor muscles (purple arrows).

     
    Area of Interest: Musculoskeletal bone; Musculoskeletal joint; Musculoskeletal soft tissue; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Abscess; Arthritides; Infection;

    T1, fs, Gd. Contrast enhancement of the articular surface (blue arrow), both pubic rami (green arrows) and the soft tissues (yellow arrow). Lymph nodes (small white arrows).

     
    Area of Interest: Musculoskeletal bone; Musculoskeletal joint; Musculoskeletal soft tissue; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Arthritides; Infection; Inflammation;

    T1, fs, Gd. Bilateral adductor muscle abscesses (black arrows) with rim enhancement (orange arrows). Enhancement of the adjacent muscle tissue (yellow arrows). Enlarged inguinal lymph nodes (small white arrows).

     
    Area of Interest: Musculoskeletal bone; Musculoskeletal joint; Musculoskeletal soft tissue; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Infection; Inflammation;

    T1, fs, Gd. Subtle rim-enhancing abscess (black arrow) in the right rectus abdominis muscle (orange arrow). Enhancement of the adjacent muscle tissue (yellow arrow). Enlarged inguinal lymph nodes (small white arrows).

     
    Area of Interest: Musculoskeletal bone; Musculoskeletal joint; Musculoskeletal soft tissue; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Abscess; Arthritides; Infection;
     
     
Widening of the symphysis (red circle).
 
Erosions in both pubic bones, larger at the left side (red arrows).
 
Widening of the symphysis. Subchondral erosion in the left pubic ramus (pink arrow).
 
Widening of the symphysis. Subchondral erosion in the left pubic ramus (pink arrow).
 
Widening of the symphysis. Intra-articular collection extending anteriorly into the soft tissues, with subtle enhancement at the margins of the collection (orange arrow).
 
Bilateral collections along the adductor muscles with butterfly morphology and subtle rim enhancement (orange arrows).
 
T1. Widening of the symphysis. Low T1 signal intensity in the pubic rami (red arrows) representing bone marrow oedema surrounding the erosions. Soft tissue extension along the adductor muscles (purple arrows).
 
T2 PD, TSE, fs. Widening of the symphysis. Bone marrow oedema in the pubic rami (red arrows). Pus in the symphysis pubis, extending along the adductor muscles (purple arrows).
 
T1, fs, Gd. Contrast enhancement of the articular surface (blue arrow), both pubic rami (green arrows) and the soft tissues (yellow arrow). Lymph nodes (small white arrows).
 
T1, fs, Gd. Bilateral adductor muscle abscesses (black arrows) with rim enhancement (orange arrows). Enhancement of the adjacent muscle tissue (yellow arrows). Enlarged inguinal lymph nodes (small white arrows).
 
T1, fs, Gd. Subtle rim-enhancing abscess (black arrow) in the right rectus abdominis muscle (orange arrow). Enhancement of the adjacent muscle tissue (yellow arrow). Enlarged inguinal lymph nodes (small white arrows).
 
 
 
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