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Porto Fuentes Ó, Trigás Ferrín M, Serrano Arreba JM, Alonso Juarros O. Emphysematous osteomyelitis of the hip and iliac bone: Serious infection with a characteristic radiographic finding. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2024:S2529-993X(24)00184-9. [PMID: 39095255 DOI: 10.1016/j.eimce.2024.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 06/15/2024] [Accepted: 06/17/2024] [Indexed: 08/04/2024]
Affiliation(s)
- Óscar Porto Fuentes
- Servicio de Medicina Interna, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain.
| | - María Trigás Ferrín
- Servicio de Medicina Interna, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Joaquín Manuel Serrano Arreba
- Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Olaya Alonso Juarros
- Servicio de Medicina Interna, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
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2
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Kou R, Onishi Y, Ogiso S, Kai S, Nakamoto Y. Emphysematous Osteomyelitis of the Lumbar Spine and Sacrum After Liver Transplantation: A Case Report. Cureus 2024; 16:e63748. [PMID: 39099963 PMCID: PMC11296323 DOI: 10.7759/cureus.63748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2024] [Indexed: 08/06/2024] Open
Abstract
Emphysematous osteomyelitis (EO) is a rare and potentially fatal disease that often occurs in patients with underlying conditions, most commonly diabetes mellitus. Herein, we report a case of a 62-year-old man who presented with fever, tachycardia, and hypotension 112 days after liver transplantation. Blood tests revealed an increased inflammatory response. Computed tomography demonstrated clusters of small gas collections in the first and second lumbar vertebral bodies and the right sacral ala, a finding characteristic of the pumice stone sign of EO. Septic shock due to EO was diagnosed. The patient responded well to treatment and recovered from the infection. This case suggests that the immunosuppressive state after liver transplantation is a risk factor for EO.
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Affiliation(s)
- Rio Kou
- Diagnostic Imaging and Nuclear Medicine, Kyoto University, Kyoto, JPN
| | - Yasuyuki Onishi
- Diagnostic Imaging and Nuclear Medicine, Kyoto University, Kyoto, JPN
| | | | | | - Yuji Nakamoto
- Diagnostic Imaging and Nuclear Medicine, Kyoto University, Kyoto, JPN
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3
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Feng X, Liu XY, Qin DA. Multiple spinal gas in an 86-year-old diabetic man. Skeletal Radiol 2024; 53:1443-1444. [PMID: 38221568 DOI: 10.1007/s00256-024-04574-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/07/2023] [Accepted: 01/05/2024] [Indexed: 01/16/2024]
Abstract
Although spinal gas is common and can be found in various sites and lesions, it should prompt a search for the underlying cause, given that the clinical significance of ectopic gas varies from benign to scary. Spinal gas can occur in the traumatic, iatrogenic, degenerative, osteoporotic, infectious, or neoplastic lesions. The imaging similarity may cause the misdiagnosis or delayed diagnosis which sometimes requires immediate attention. The pattern of gas distribution, detailed appearance, clinical history, and findings on examination can provide clues to diagnosis. Computed tomography is the best method for sensitive detection of gas.
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Affiliation(s)
- Xin Feng
- Department of Orthopedics, Meihe Hospital of the First Hospital of Jilin University, Changchun, China
| | - Xing-Yong Liu
- Department of Medical Imaging Center, Shanxi Provincial People's Hospital, Taiyuan, China
| | - De-An Qin
- Department of Orthopedics, Shanxi Provincial People's Hospital, NO. 29, Double Tower Street, Taiyuan, 030012, Shanxi, China.
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4
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Shiran SI, Pratt LT, DeRowe A, Matot S, Neiderman NC, Wasserzug O. The Clinical Value of Cranial CT Venography for Predicting Fusobacterium necrophorum as the Causative Agent in Children with Complicated Acute Mastoiditis. AJNR Am J Neuroradiol 2024; 45:761-768. [PMID: 38724201 PMCID: PMC11288586 DOI: 10.3174/ajnr.a8217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 02/05/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND AND PURPOSE Fusobacterium necrophorum (F necrophorum) is an anaerobic bacteria that causes invasive head and neck infections in children. Several studies have demonstrated an increasing prevalence of F necrophorum as the causative agent in acute mastoiditis in children, with associated high rates of intracranial complications such as epidural abscess and sinus venous thrombosis, to name a few. F necrophorum requires a treatment protocol that differs from the empiric treatment that is tailored to more common pathogens (eg, group A streptococci, Streptococcus pneumonia), and hence expediting the diagnosis is important. For evaluating complicated acute mastoiditis in children, cranial CT venography remains the imaging study of choice in most medical centers due to its availability in emergency situations. Based on our clinical experience, our hypothesis is that children with F necrophorum-associated complicated acute mastoiditis can be differentiated from those with other etiologies using CT venography. MATERIALS AND METHODS CT venography studies of 76 children hospitalized and treated for complicated acute mastoiditis were retrospectively reviewed. Retrieved imaging data included intracranial complications (epidural abscess, sinus venous thrombosis), cranial bone-related complications, and extracranial complications (subperiosteal abscess, temporomandibular joint abscess, and soft-tissue inflammation). The cohort was divided into children with F necrophorum-related disease (study group) and those with non-F necrophorum-related disease (control group). RESULTS Thirty-seven children (49%) comprised the study group, and 39 children in whom the causative agents were other bacteria comprised the control group. There were significantly higher rates of complications in the study group: sinus venous thrombosis (P < .001), perisigmoid epidural abscess (P = .036), and extramastoid osteomyelitis (P < .001). Thrombosis in venous sites beyond the sigmoid sinus and jugular foramen (a pattern consistent with an otogenic variant of Lemierre syndrome) and emphysematous osteomyelitis were found only among children in the F necrophorum-related study group (32% and 22% accordingly). CONCLUSIONS In children with complicated acute mastoiditis, CT venography findings of emphysematous osteomyelitis and/or thrombosis in venous sites beyond the sigmoid sinus and jugular foramen (a pattern consistent with the otogenic variant of Lemierre syndrome) should lead the radiologist to suggest F necrophorum-related mastoiditis.
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Affiliation(s)
- Shelly I Shiran
- From the Department of Radiology (S.I.S., L.-t.P.), Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Li-Tal Pratt
- From the Department of Radiology (S.I.S., L.-t.P.), Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ari DeRowe
- Pediatric Otorhinolaryngology Unit, "Dana" Children's Hospital (A.D., O.W.), Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Sophie Matot
- Department of Otolaryngology, Head & Neck and Maxillofacial Surgery (S.M., N.C.N.), Tel Aviv Sourasky Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Narin Carmel Neiderman
- Department of Otolaryngology, Head & Neck and Maxillofacial Surgery (S.M., N.C.N.), Tel Aviv Sourasky Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oshri Wasserzug
- Pediatric Otorhinolaryngology Unit, "Dana" Children's Hospital (A.D., O.W.), Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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5
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Tan WC, Lau SCX, Lim YT. Pumice stone sign: Emphysematous osteomyelitis in diabetic ketoacidosis. Int J Infect Dis 2024; 143:106977. [PMID: 38401780 DOI: 10.1016/j.ijid.2024.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/16/2024] [Accepted: 02/19/2024] [Indexed: 02/26/2024] Open
Affiliation(s)
- Wei Chuan Tan
- Department of Diagnostic Imaging, National University Hospital, Singapore.
| | | | - Yi Ting Lim
- Department of Diagnostic Imaging, National University Hospital, Singapore
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6
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Saha D, Tai R, Kapare V, Joshi G. Multifocal emphysematous osteomyelitis, a do not miss diagnosis for the emergency radiologist: a case report with literature review. Emerg Radiol 2024; 31:285-288. [PMID: 38267799 DOI: 10.1007/s10140-024-02203-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 01/10/2024] [Indexed: 01/26/2024]
Abstract
Emphysematous osteomyelitis (EO) is an uncommon fatal condition with high morbidity and mortality. Simultaneous involvement of the axial and appendicular skeleton with multifocal disease is even rarer, with only a few cases being reported in the literature. We present a case of multifocal emphysematous osteomyelitis in a 56-year-old woman with concurrent emphysematous pyelonephritis complicated by psoas and epidural abscesses. The causative organism in our patient was Escherichia coli. Emergency radiologists should be aware of this condition and differentiate it from other benign entities that can present with intraosseous gas. Prompt diagnosis is important given the high morbidity and mortality with this condition. This case report emphasizes the specific pattern of intraosseous gas seen with EO, which can help diagnose EO with confidence.
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Affiliation(s)
- Debajyoti Saha
- Department of Radiology Chan Medical School, University of Massachusetts, UMass Memorial Medical Center, 55 Lake Avenue North, Worcester, MA, 0165, USA.
| | - Ryan Tai
- Department of Radiology Chan Medical School, University of Massachusetts, UMass Memorial Medical Center, 55 Lake Avenue North, Worcester, MA, 0165, USA
| | - Vaishali Kapare
- Department of Radiology Chan Medical School, University of Massachusetts, UMass Memorial Medical Center, 55 Lake Avenue North, Worcester, MA, 0165, USA
| | - Ganesh Joshi
- Department of Radiology Chan Medical School, University of Massachusetts, UMass Memorial Medical Center, 55 Lake Avenue North, Worcester, MA, 0165, USA
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7
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Khan A, Zaidi FN, Anwar M, Ahmad M, Rehman AU. Emphysematous Osteomyelitis Involving the Spine, a Case of a Rare Form of Osteomyelitis. Cureus 2023; 15:e41208. [PMID: 37525769 PMCID: PMC10387325 DOI: 10.7759/cureus.41208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2023] [Indexed: 08/02/2023] Open
Abstract
Gas-forming bacteria like Staphylococcus aureus (SA), along with the worrisome infections it causes, can lead to a fairly overlooked but lethal complication, called emphysematous osteomyelitis (EO). It is a condition characterized by the infection of bones complicated by the presence of gas-forming organisms. Here, we present a 50-year-old woman with insulin-dependent type 2 diabetes, who presented with cough, high-grade fevers, rigors, chills, and back pain from the last seven days. Laboratory tests revealed elevated inflammatory markers and a hyperosmolar hyperglycemic state. Sputum smear and blood cultures both reported the presence of SA. The presence of air foci in the third lumbar spine vertebra (L3) and the surrounding soft tissue was confirmed by computed tomography (CT). The posterior elements were spared, and the vertebral height and intervertebral disc were preserved. The extent of the damage done to the bone was analyzed by magnetic resonance imaging (MRI). The findings showed transverse relaxation time (T2) and short tau inversion recovery (STIR) sequences, consistent with the diagnosis of EO. She was put on strict glucose monitoring and a combination of intravenous antibiotics for three weeks followed by two weeks of oral therapy. Her symptoms improved with conservative management and reported no recurrence of any symptom of such type ever since.
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Affiliation(s)
- Adil Khan
- Internal Medicine, Khyber Medical College, Peshawar, PAK
| | - Farah N Zaidi
- Medicine, Queen Elizabeth Hospital, King's Lynn, GBR
| | - Maryem Anwar
- Family Medicine, National Health Service (NHS), Slough, GBR
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Moon TJ, Ina J, Raji Y, Padubidri A, Sontich J. Emphysematous Osteomyelitis of the Pubis Associated With Necrotizing Soft Tissue Infection of the Thigh. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202305000-00008. [PMID: 37141508 PMCID: PMC10155894 DOI: 10.5435/jaaosglobal-d-21-00088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 02/27/2023] [Indexed: 05/06/2023]
Abstract
Emphysematous osteomyelitis (EO) is a rare condition identified through the presence of intraosseous gas. It is frequently fatal even with prompt recognition and management. We report a case of EO presenting with a necrotizing soft tissue infection of the thigh in the setting of prior pelvic radiation. The purpose of this study was to highlight the unusual association between EO and necrotizing soft tissue infection.
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Affiliation(s)
- Tyler J Moon
- From the Department of Orthopedic Surgery, University Hospitals Cleveland Medical Center/Case Western Reserve University
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Kang YH, Lee SS, Aung MTZ, Kang JH, Kim JE, Huh KH, Heo MS. Mucormycosis-related osteomyelitis of the maxilla in a post-COVID-19 patient. Imaging Sci Dent 2022; 52:435-440. [PMID: 36605866 PMCID: PMC9807792 DOI: 10.5624/isd.20220143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/30/2022] [Accepted: 10/05/2022] [Indexed: 12/28/2022] Open
Abstract
Mucormycosis is a rare, invasive fungal infection that progresses aggressively and requires prompt surgery and appropriate treatment. The number of cases of mucormycosis in coronavirus disease 2019 (COVID-19) patients has recently increased, and patients with uncontrolled diabetes mellitus are particularly at an elevated risk of infection. This report presents a case of mucormycosis-related osteomyelitis of the maxilla in a 37-year-old man with diabetes mellitus. The patient complained of severe and persistent pain in the right maxilla, accompanied by increased tooth mobility and headache. On contrast-enhanced computed tomographic images, gas-forming osteomyelitis of the right maxilla was observed. Destruction of the maxilla and palatine bone then proceeded aggressively. Sequestrectomy was performed on the right maxilla, and the histopathological diagnosis was mucormycosis. Further investigation after the first operation revealed the patient's history of COVID-19 infection.
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Affiliation(s)
- Yun-Hui Kang
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Seoul National University, Seoul, Korea
| | - Sam-Sun Lee
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Seoul National University, Seoul, Korea
| | - Moe Thu Zar Aung
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Seoul National University, Seoul, Korea.,Department of Oral Medicine, University of Dental Medicine, Mandalay, Myanmar
| | - Ju-Hee Kang
- Department of Oral and Maxillofacial Radiology, Seoul National University Dental Hospital, Seoul, Korea
| | - Jo-Eun Kim
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Seoul National University, Seoul, Korea
| | - Kyung-Hoe Huh
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Seoul National University, Seoul, Korea
| | - Min-Suk Heo
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Seoul National University, Seoul, Korea
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Ghosen J, Lucasti C, Daoust S. Parvimonas micra Causing Emphysematous Osteomyelitis: A Case Report. JBJS Case Connect 2022; 12:01709767-202212000-00007. [PMID: 36240293 DOI: 10.2106/jbjs.cc.22.00247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 07/10/2022] [Indexed: 11/06/2022]
Abstract
CASE We present an interesting case of femoral emphysematous osteomyelitis (EO) in a 67-year-old patient with the offending pathogen to be Parvimonas micra. Two knee arthrotomies with lateral thigh exploration were performed to debride and irrigate the bone and compartments. Although the patient initially improved, definitive treatment with an antibiotic intramedullary rod was necessary and resulted in complete resolution. CONCLUSION We present the first case of EO secondary to P. micra described in the literature and recommend aggressive surgical management for complete resolution and preserved functional outcome.
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Affiliation(s)
- James Ghosen
- University at Buffalo Jacobs School of Medicine, Buffalo, New York
| | | | - Susan Daoust
- UBMD Orthopaedics and Sports Medicine, Buffalo, New York
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11
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Lee D, Mohile N, Rakoczy K, Gjolaj JP. Emphysematous osteomyelitis of the spine: a case report and case based review of the literature. JOURNAL OF SPINE SURGERY (HONG KONG) 2022; 8:362-376. [PMID: 36285094 PMCID: PMC9547692 DOI: 10.21037/jss-22-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 05/20/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND/OBJECTIVE Emphysematous osteomyelitis (EO) of the spine is an uncommon type of osteomyelitis characterized by intraosseous gas-formation in the vertebrae. The objective of this report is to present a rare case of spine EO in a patient with emphysematous cystitis. A case-based review of the literature on spinal EO was also performed as an update to the relevant literature of this rare infection. CASE DESCRIPTION/METHODS A 55-year-old female with diabetes mellitus and peripheral vascular disease (PVD) presented to our institution with recurrent falls, fatigue, and low back pain. Computed tomography (CT) and magnetic resonance imaging (MRI) scans confirmed emphysematous cystitis and EO at L4. Given the diffuse involvement, surgical intervention was deferred for IV antibiotic therapy. A case-based review was also conducted by searching the SCOPUS and PubMed databases for the following terms: "emphysematous osteomyelitis", "gas", and "spine". Only publications in English were included in this review. KEY CONTENT/FINDINGS Urine/blood cultures identified Klebsiella pneumoniae. After initial improvement with six weeks of broad-spectrum antibiotics, the patient re-presented with recurrent fevers and fatigue. Despite maximal medical therapy, the patient expired 2 months later due to multi-organ system failure. Including the present report, only 29 cases of spine EO have been described in the literature. Patients almost consistently presented with fever, elevated inflammatory markers, and localized pain. Most cases of spinal EO (89.7%) were monomicrobial. Escherichia coli (37.9%) and Klebsiella pneumoniae (27.6%) were the most causative organisms identified. Medical treatment universally consisted of broad-spectrum IV antibiotics prior to tailoring. Debridement and decompression, with or without fusion, were the main operative procedures performed for spine EO. Outcomes following spinal EO are varied with a 44.4% mortality rate. CONCLUSIONS We present a case of EO of the spine and concomitant emphysematous cystitis with Klebsiella pneumoniae and a case-based review of the literature. Appropriate work up for this rare infection should include inflammatory markers, cultures, and CT/MRI imaging. Treatment consists of IV antibiotics with anaerobic and gram-negative coverage. However, treatment guidelines and operative indications for spinal emphysematous osteomyelitis remain unclear.
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Affiliation(s)
- Danny Lee
- Department of Orthopaedic Surgery, University of Miami-Jackson Memorial Health System, Miami, FL, USA
| | - Neil Mohile
- Department of Orthopaedic Surgery, University of Miami-Jackson Memorial Health System, Miami, FL, USA
| | - Kyla Rakoczy
- Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Joseph P. Gjolaj
- Department of Orthopaedic Surgery, University of Miami-Jackson Memorial Health System, Miami, FL, USA
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Sachdev IS, Tomer N, Bethapudi S, Priya S, Atwal S. A Rare Case of Emphysematous Osteomyelitis of Femur in an Intravenous Drug User. Cureus 2021; 13:e16782. [PMID: 34513389 PMCID: PMC8405401 DOI: 10.7759/cureus.16782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2021] [Indexed: 11/05/2022] Open
Abstract
Emphysematous osteomyelitis (EO) is a rare condition characterized by the appearance of gas locules within the bone on imaging, usually as a result of anaerobic bacterial infection. We present the case of a 46-year-old known intravenous (IV) drug user who was admitted to the emergency department with intractable pain in the right groin. He was febrile with elevated white cell count and C-reactive protein. He underwent an X-ray and CT of the pelvis which demonstrated intraosseous gas in the proximal right femur. A diagnosis of EO was made radiologically, allowing for prompt antibiotic treatment and a plan for surgical debridement. There are only a handful of published cases of EO in the literature, only one of which has described IV drug use as the underlying factor.
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Affiliation(s)
| | - Neeru Tomer
- Radiology, County Durham and Darlington NHS Foundation Trust, Darlington, GBR
| | - Sarath Bethapudi
- Radiology, County Durham and Darlington NHS Foundation Trust, Darlington, GBR
| | - Sarv Priya
- Radiology, University of Iowa Hospitals and Clinics, Iowa City, USA
| | - Swapndeep Atwal
- Radiology, County Durham and Darlington NHS Foundation Trust, Darlington, GBR
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13
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Osawa H, Komagamine J, Sato Y. Gas in Vertebrae. Am J Med 2021; 134:e420-e421. [PMID: 33621534 DOI: 10.1016/j.amjmed.2020.12.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 12/29/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Haruka Osawa
- Department of Internal Medicine, National Hospital Organization Tochigi Medical Center, Utsunomiya, Tochigi, Japan.
| | - Junpei Komagamine
- Department of Internal Medicine, National Hospital Organization Tochigi Medical Center, Utsunomiya, Tochigi, Japan
| | - Yukako Sato
- Department of Internal Medicine, National Hospital Organization Tochigi Medical Center, Utsunomiya, Tochigi, Japan
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Chamsi Basha A, Khalifa MA, Albadr F, Kaid J, Alsakkaf H. Hip bone osteonecrosis with intraosseous pneumatosis after abdominal aortic aneurysm repair: a case of emphysematous osteomyelitis. BJR Case Rep 2021; 7:20200138. [PMID: 33614123 PMCID: PMC7869127 DOI: 10.1259/bjrcr.20200138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 10/07/2020] [Accepted: 10/10/2020] [Indexed: 11/09/2022] Open
Abstract
Intraosseous pneumatosis is a rare and often fatal condition characterised by air accumulation in the bone that may be brought about by infection, trauma (surgical or otherwise), degenerative disease or neoplastic processes. Here, we present a case of pelvic emphysematous osteomyelitis following repair of an infected abdominal aortic aneurysm. A 56-year-old Saudi male, known to have diabetes and hypertension, presented to the emergency department complaining of intermittent abdominal pain over the right lower quadrant. The patient was later diagnosed intraoperatively with an infected abdominal aortic aneurysm and treated appropriately. During multiple follow-up imaging studies, the patient was noted to have multiple intra-abdominal fluid collections, as well as intraosseous pneumatosis in the pelvis and right femur. 3 months later, intervention was again required due to patient deterioration and possible aortic graft leakage. Graft abscess was diagnosed and managed. We present a case of an infected abdominal aortic aneurysm that eventually led to emphysematous osteomyelitis of the pelvis. This case report sheds light on intraosseous pneumatosis and emphysematous osteomyelitis, which is characterised by the former, in addition to signs of an underlying infection or abscess formation.
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Affiliation(s)
- Amjad Chamsi Basha
- College of Medicine, Sulaiman AlRajhi University PO Box 777, Al Bukairiyah, Saudi Arabia
| | | | - Fahad Albadr
- Department of Radiology, College of Medicine, King Saud University PO Box 145111, Riyadh, Saudi Arabia
| | - Jamal Kaid
- King Saud University Medical City, Department of Radiology, PO Box 2925, Riyadh, Saudi Arabia
| | - Hussein Alsakkaf
- King Saud University Medical City, Department of Radiology, PO Box 2925, Riyadh, Saudi Arabia
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15
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Extensive multifocal emphysematous osteomyelitis: fatal outcome in a patient with psychiatric history. Skeletal Radiol 2020; 49:1487-1493. [PMID: 32447471 DOI: 10.1007/s00256-020-03470-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 05/09/2020] [Accepted: 05/12/2020] [Indexed: 02/02/2023]
Abstract
Emphysematous osteomyelitis is a rare entity with potentially devastating consequences, even after prompt and aggressive intervention. It is characterized by intraosseous gas and may be complicated by adjacent abscess formation. There are a handful of previously reported cases of emphysematous osteomyelitis, but none to the degree as reported here. Specifically, we report an extremely rare case of extensive multifocal emphysematous osteomyelitis involving both the axial and appendicular skeleton in a 20-year-old woman.
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16
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Spontaneous emphysematous osteomyelitis of the spine: A case report. Radiol Case Rep 2020; 15:1552-1554. [PMID: 34168712 PMCID: PMC8206567 DOI: 10.1016/j.radcr.2020.05.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/22/2020] [Accepted: 05/24/2020] [Indexed: 11/24/2022] Open
Abstract
Spontaneous emphysematous osteomyelitis of the spine is a very rare but severe condition caused by gas-forming microorganisms. We present the case of a 41-year-old obese male patient presenting at the Emergency Department with diabetic ketoacidosis, fever, and difficulty in walking. computed tomography and magnetic resonance imaging of the spine revealed bone marrow edema and intraosseous gas collections at the level of the fourth and fifth lumbar metameres, suggesting an osteomyelitis sustained by gas-forming microorganisms, which was then confirmed by the isolation of Klebsiella pneumonia in blood culture. Imaging plays a central role for the diagnosis of emphysematous osteomyelitis: the presence of multiple intraosseous gas collections of variable size, especially in patients with specific risk factors, is highly suggestive of an infection caused by gas-forming pathogens. Being familiar with this peculiar neuroradiological appearance is essential to ensure an early diagnosis and a timely antimicrobial therapy, which can considerably ameliorate the prognosis.
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Leturia Etxeberria M, Biurrun Mancisidor MC, Ugarte Nuño A, Arenaza Choperena G, Mendoza Alonso M, Esnaola Albizu M, Serdio Mier A, Gredilla Sáenz M, Gomez Usabiaga V. Imaging Assessment of Ectopic Gas Collections. Radiographics 2020; 40:1318-1338. [DOI: 10.1148/rg.2020200028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Maria Leturia Etxeberria
- From the Department of Radiology, Donostia University Hospital, Paseo Dr. Beguiristain 109, 20014 Donostia–San Sebastián, Gipuzkoa, Spain
| | - Maria Carmen Biurrun Mancisidor
- From the Department of Radiology, Donostia University Hospital, Paseo Dr. Beguiristain 109, 20014 Donostia–San Sebastián, Gipuzkoa, Spain
| | - Ane Ugarte Nuño
- From the Department of Radiology, Donostia University Hospital, Paseo Dr. Beguiristain 109, 20014 Donostia–San Sebastián, Gipuzkoa, Spain
| | - Gorka Arenaza Choperena
- From the Department of Radiology, Donostia University Hospital, Paseo Dr. Beguiristain 109, 20014 Donostia–San Sebastián, Gipuzkoa, Spain
| | - Miguel Mendoza Alonso
- From the Department of Radiology, Donostia University Hospital, Paseo Dr. Beguiristain 109, 20014 Donostia–San Sebastián, Gipuzkoa, Spain
| | - Maite Esnaola Albizu
- From the Department of Radiology, Donostia University Hospital, Paseo Dr. Beguiristain 109, 20014 Donostia–San Sebastián, Gipuzkoa, Spain
| | - Alberto Serdio Mier
- From the Department of Radiology, Donostia University Hospital, Paseo Dr. Beguiristain 109, 20014 Donostia–San Sebastián, Gipuzkoa, Spain
| | - María Gredilla Sáenz
- From the Department of Radiology, Donostia University Hospital, Paseo Dr. Beguiristain 109, 20014 Donostia–San Sebastián, Gipuzkoa, Spain
| | - Virginia Gomez Usabiaga
- From the Department of Radiology, Donostia University Hospital, Paseo Dr. Beguiristain 109, 20014 Donostia–San Sebastián, Gipuzkoa, Spain
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Elshikh A, Gowda N, Glass L, Maximos RB. Emphysematous osteomyelitis of the clavicle: a pleural process? BMJ Case Rep 2020; 13:13/7/e235764. [PMID: 32723778 DOI: 10.1136/bcr-2020-235764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Emphysematous osteomyelitis (EO) is a rare infection associated with intraosseous gas. EO is an often fatal disease with an estimated 34% mortality. We present a case of a 63-year-old man with sternoclavicular EO with pleural involvement and significant subcutaneous emphysema diagnosed by CT. Extension of intraosseous gas into the pleural cavity is an extremely interesting presentation that has not been previously reported. The patient underwent a multidisciplinary treatment approach with surgical debridement and an extended antibiotic course. Intraoperative cultures of the pectoralis muscle and bone biopsy grew pan-sensitive Escherichia coli Prompt recognition and treatment are paramount to avoid a potentially fatal outcome. A review of the literature of the previous 46 cases of EO is presented for associated risk factors, the role of surgical management and antibiotic therapy.
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Affiliation(s)
- Amira Elshikh
- Internal Medicine, George Washington University, Washington, District of Columbia, USA
| | - Niraj Gowda
- Internal Medicine, George Washington University, Washington, District of Columbia, USA
| | - Lisa Glass
- Division of Pulmonary, Critical Care and Sleep Disorders Medicine, Department of Medicine, George Washington University, Washington, District of Columbia, USA
| | - Robert B Maximos
- Pulmonary, Critical Care and Sleep Disorders Medicine, The George Washington University Hospital, Washington, District of Columbia, USA.,Pulmonary and Critical Care, Department of Veterans Affairs, Washington, District of Columbia, USA
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Sung S, Lee BH, Kim JH, Park Y, Ha JW, Moon SH, Lee HM, Kwon JW. Emphysematous osteomyelitis of the spine: A rare case report. Medicine (Baltimore) 2020; 99:e21113. [PMID: 32664134 PMCID: PMC7360287 DOI: 10.1097/md.0000000000021113] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Emphysematous osteomyelitis is a rare disease caused by gas-forming bacteria. But only 45 cases have been reported in the literature since then. PATIENT CONCERNS A 72-year-old female presented to our hospital with severe lower back pain that aggravated 4 days ago. DIAGNOSES Computed tomography (CT) revealed intraosseous mottled air in the T12 and L1 vertebral bodies and epidural space. The enhanced T1 and T2 magnetic resonance imaging scans showed heterogeneous signal intensity of vertebral bodies, suggestive of emphysematous osteomyelitis. INTERVENTIONS Surgery was performed to identify culture strains and to remove emphysematous lesions of the vertebral body using extensive transpedicular irrigation. OUTCOMES Escherichia coli (E coli) was identified in the surgical specimen, and intravenous antibiotic therapy was continued with cefotaxime. The patient had a significant decrease in lower back pain after the surgery and the final CT scan before discharge revealed significantly decreased air at T12 and L1 vertebral bodies and no air density in the epidural space. LESSONS We present a patient diagnosed with emphysematous osteomyelitis in vertebral bodies caused by E coli and successfully treated with surgical intervention.
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Affiliation(s)
- Sahyun Sung
- Department of Orthopedic Surgery, Yonsei University College of Medicine
- Department of Orthopedic Surgery, College of Medicine, Ewha Womans University Seoul Hospital, Seoul
| | - Byung Ho Lee
- Department of Orthopedic Surgery, Yonsei University College of Medicine
| | - Jung-Hwan Kim
- Department of Orthopedic Surgery, Yonsei University College of Medicine
| | - Yung Park
- Department of Orthopedic Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Joong Won Ha
- Department of Orthopedic Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Seong-Hwan Moon
- Department of Orthopedic Surgery, Yonsei University College of Medicine
| | - Hwan-Mo Lee
- Department of Orthopedic Surgery, Yonsei University College of Medicine
| | - Ji-Won Kwon
- Department of Orthopedic Surgery, Yonsei University College of Medicine
- Department of Orthopedic Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
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