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Chronic Osteomyelitis
Cheryl A. Petersilge, MD, MBA
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            TERMINOLOGY

            • Definitions

              • Brodie abscess: Subacute osteomyelitis with intraosseous abscess formation
              • Chronic osteomyelitis: Persistent infection of bone despite treatment, evolves over months to years
                • Chronic indolent osteomyelitis: Low-grade infection without episodes of activity/inflammation
                • Chronic relapsing course: Intermittent periods of active inflammation
              • Cloaca: Defect in bone caused by spontaneous decompression of infection
              • Involucrum: New bone formation by periosteum around infected bone, occurs in attempt to wall off infection; more common in children who have looser attachment of periosteum to cortex
              • Marjolin ulcer: Ulcerating squamous cell carcinoma at site of chronic irritation/inflammation
              • Sequestrum: Devascularized fragment of bone
                • Variable size from small fragment to entire bone

            IMAGING

            • General Features

              • Imaging Recommendations

                • Radiographic Findings

                  • CT Findings

                    • MR Findings

                      • Nuclear Medicine Findings

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Microscopic Features

                              CLINICAL ISSUES

                              • Presentation

                                • Demographics

                                  • Natural History & Prognosis

                                    • Treatment

                                      Selected References

                                      1. Monaco SJ et al: Squamous cell carcinoma with chronic osteomyelitis: a case report. Foot Ankle Spec. 8(6):529-31, 2015
                                      2. Gülabi D et al: Treatment of chronic osteomyelitis of the femur with combined technique. Eklem Hastalik Cerrahisi. 25(3):173-8, 2014
                                      3. Panteli M et al: Malignant transformation in chronic osteomyelitis: recognition and principles of management. J Am Acad Orthop Surg. 22(9):586-594, 2014
                                      4. Wu JS et al: Imaging-guided bone biopsy for osteomyelitis: are there factors associated with positive or negative cultures? AJR Am J Roentgenol. 188(6):1529-34, 2007
                                      5. Zuluaga AF et al: Etiologic diagnosis of chronic osteomyelitis: a prospective study. Arch Intern Med. 166(1):95-100, 2006
                                      6. Mason MD et al: Chronic complicated osteomyelitis of the lower extremity: evaluation with MR imaging. Radiology. 173(2):355-9, 1989
                                      Related Anatomy
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                                      Related Differential Diagnoses
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                                      References
                                      Tables

                                      Tables

                                      KEY FACTS

                                      • Terminology

                                        • Imaging

                                          • Top Differential Diagnoses

                                            • Pathology

                                              • Clinical Issues

                                                TERMINOLOGY

                                                • Definitions

                                                  • Brodie abscess: Subacute osteomyelitis with intraosseous abscess formation
                                                  • Chronic osteomyelitis: Persistent infection of bone despite treatment, evolves over months to years
                                                    • Chronic indolent osteomyelitis: Low-grade infection without episodes of activity/inflammation
                                                    • Chronic relapsing course: Intermittent periods of active inflammation
                                                  • Cloaca: Defect in bone caused by spontaneous decompression of infection
                                                  • Involucrum: New bone formation by periosteum around infected bone, occurs in attempt to wall off infection; more common in children who have looser attachment of periosteum to cortex
                                                  • Marjolin ulcer: Ulcerating squamous cell carcinoma at site of chronic irritation/inflammation
                                                  • Sequestrum: Devascularized fragment of bone
                                                    • Variable size from small fragment to entire bone

                                                IMAGING

                                                • General Features

                                                  • Imaging Recommendations

                                                    • Radiographic Findings

                                                      • CT Findings

                                                        • MR Findings

                                                          • Nuclear Medicine Findings

                                                            DIFFERENTIAL DIAGNOSIS

                                                              PATHOLOGY

                                                              • General Features

                                                                • Microscopic Features

                                                                  CLINICAL ISSUES

                                                                  • Presentation

                                                                    • Demographics

                                                                      • Natural History & Prognosis

                                                                        • Treatment

                                                                          Selected References

                                                                          1. Monaco SJ et al: Squamous cell carcinoma with chronic osteomyelitis: a case report. Foot Ankle Spec. 8(6):529-31, 2015
                                                                          2. Gülabi D et al: Treatment of chronic osteomyelitis of the femur with combined technique. Eklem Hastalik Cerrahisi. 25(3):173-8, 2014
                                                                          3. Panteli M et al: Malignant transformation in chronic osteomyelitis: recognition and principles of management. J Am Acad Orthop Surg. 22(9):586-594, 2014
                                                                          4. Wu JS et al: Imaging-guided bone biopsy for osteomyelitis: are there factors associated with positive or negative cultures? AJR Am J Roentgenol. 188(6):1529-34, 2007
                                                                          5. Zuluaga AF et al: Etiologic diagnosis of chronic osteomyelitis: a prospective study. Arch Intern Med. 166(1):95-100, 2006
                                                                          6. Mason MD et al: Chronic complicated osteomyelitis of the lower extremity: evaluation with MR imaging. Radiology. 173(2):355-9, 1989