EURORAD ESR

Case 8912

Chronic Recurrent Multifocal Osteomyelitis (ECR 2010 Case of the Day)

Author(s)
Gonçalves LP, Reijnierse M.
 
Patient
female, 18 year(s)
 
 
  • Figure 1
    anteroposterior clavicle radiograph

    Predominantly sclerotic lesion, marked expansion and solid periosteal reaction on the medial two-thirds of the left clavicle

     
    Area of Interest: Musculoskeletal system; Imaging Technique: Plain radiographic studies;
     
     
  • Figure 2
    posteroanterior chest radiograph

    A similar sclerotic lesion with expansion is visualised on anterior aspect of the 6th right rib

     
     
     
  • Figure 3
    rib detail

    Anterior aspect of the 6th right rib showing expansion and sclerosis

     
     
     
  • Figure 4
    Tc-99m methylene diphosphonate bone scintigraphy

    Increased uptake in the locations previously described as well as in the 5th right rib, the latter being radiographically occult

     
    Area of Interest: Musculoskeletal bone; Imaging Technique: Nuclear medicine conventional;
     
     
  • Figure 5
    MRI of the left clavicle. Axial T1W image

    Intramedullary lesion with predominantly low signal intensity. Peripheral, soft tissue component with intermediate signal intensity

     
    Area of Interest: Musculoskeletal bone; Imaging Technique: MR;
     
     
  • Figure 6
    Axial T2W fat sat image

    The intra medullary lesion remains predominantly of low SI due to sclerosis; Focal areas of high SI both intramedullary and in the soft tissues are seen

     
     
     
  • Figure 7
    Axial T1W fat sat after i.v. contrast

    Intense inhomogeneous enhancement after gadolinium, consistent with the areas of high SI on T2.

     
     
     
  • Figure 8
    Sagittal T1W fat sat after i.v. contrast

    Predominant peripheral enhancement is appreciated

     
     
     
Predominantly sclerotic lesion, marked expansion and solid periosteal reaction on the medial two-thirds of the left clavicle
 
A similar sclerotic lesion with expansion is visualised on anterior aspect of the 6th right rib
 
Anterior aspect of the 6th right rib showing expansion and sclerosis
 
Increased uptake in the locations previously described as well as in the 5th right rib, the latter being radiographically occult
 
Intramedullary lesion with predominantly low signal intensity. Peripheral, soft tissue component with intermediate signal intensity
 
The intra medullary lesion remains predominantly of low SI due to sclerosis; Focal areas of high SI both intramedullary and in the soft tissues are seen
 
Intense inhomogeneous enhancement after gadolinium, consistent with the areas of high SI on T2.
 
Predominant peripheral enhancement is appreciated
 
 
 
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