Imaging-Guided Bone Biopsy for Osteomyelitis: Are There Factors Associated with Positive or Negative Cultures?
|
|
- Agatha Aileen Gibson
- 6 years ago
- Views:
Transcription
1 Imaging-Guided Bone Biopsy for Osteomyelitis Musculoskeletal Imaging Original Research Jim S. Wu 1 Tetyana Gorbachova 2 William B. Morrison 3 Andrew H. Haims 4 Wu JS, Gorbachova T, Morrison WB, Haims AH Keywords: biopsy, bone, CT, fluoroscopy, infectious diseases, osteomyelitis DOI: /AJR Received September 27, 2006; accepted after revision January 26, Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave., Shapiro 4th Fl., Boston, MA Address correspondence to J. S. Wu (jswu@bidmc.harvard.edu). 2 Department of Radiology, Hahnemann University Hospital, Philadelphia, PA. 3 Department of Radiology, Thomas Jefferson Medical College, Philadelphia, PA. 4 Department of Diagnostic Radiology, Yale University, New Haven, CT. AJR 2007; 188: X/07/ American Roentgen Ray Society Imaging-Guided Bone Biopsy for Osteomyelitis: Are There Factors Associated with Positive or Negative Cultures? OBJECTIVE. The objective of our study was to identify the clinical and technical factors associated with positive or negative culture results in histologically positive cases of osteomyelitis obtained from imaging-guided bone biopsies. MATERIALS AND METHODS. A retrospective review was performed of 800 consecutive patients undergoing imaging-guided core bone biopsies at two institutions. Seventy-five biopsies were performed for suspected osteomyelitis and 41 patients had histologically proven osteomyelitis. A chart review was performed to determine whether the following factors affected the culture result: histologic type of osteomyelitis, antibiotic therapy before biopsy, fever (temperature 38.0 C), elevated WBC count ( μl), elevated erythrocyte sedimentation rate (ESR) ( 10 mm/h), elevated C-reactive protein value (CRP) ( 6 mg/l), the size of the biopsy needle, and the amount of purulent fluid obtained at biopsy. RESULTS. Of the 41 cases of osteomyelitis, 14 (34%) had positive cultures. Eighteen (44%) of 41 cases were chronic osteomyelitis. Seventeen (41%) of 41 patients received antibiotics before biopsy, seven (17%) were febrile, five (12%) had an elevated WBC count, 16 (39%) had an elevated ESR, and six (15%) had an elevated CRP value. The biopsy needle size ranged from 11- to 18-gauge. These factors did not have any significant association with positive or negative culture results. Purulent fluid was aspirated in 10 (24%) of the 41 cases. In six (15%) of the cases, 2 ml of purulent fluid was aspirated and five (83%) of the six cases were associated with positive culture (p =0.02). CONCLUSION. The rate of positive culture results in histologically proven cases of osteomyelitis obtained from imaging-guided bone biopsies is low. Aspirating 2 ml of purulent fluid is associated with a significantly higher rate of positive cultures. steomyelitis is characterized by inflammation of the bone marrow and O adjacent bone and is often associated with cortical and trabecular destruction. It can be caused by bacteria, fungi, and a variety of other organisms [1]. Early diagnosis and treatment of osteomyelitis are essential because undiagnosed cases can lead to chronic pain, amputation, and death [2, 3]. Unfortunately, diagnosing osteomyelitis is difficult. Although clinical symptoms; inflammatory markers in the blood; and findings on MRI, leukocyte scintigraphy, and PET can suggest osteomyelitis, the definitive diagnosis of osteomyelitis is made by culturing an organism directly from the site of infection [3 6]. The identification of a causative organism by culture both confirms osteomyelitis and allows tailoring of antimicrobial therapy; however, cultures from samples obtained during surgery or by imaging guidance are often negative. Several studies suggest that 40 60% of histologically proven cases of osteomyelitis at surgery or biopsy are negative at culture, but many of these studies involve small patient populations [5 8]. The factors that predict positive or negative culture results are unknown. Treatment with antimicrobial therapy around the time of tissue sampling, small biopsy tissue volume, and sampling error are factors that may affect culture results [2, 9 12]. In several studies, investigators have stressed the importance of sending both histologic and microbiologic samples at the time of biopsy given the low rate of positive culture [5 7, 11]. Clinical and laboratory factors associated with osteomyelitis include fever, elevated WBC count, elevated erythrocyte sedimentation rate (ESR), and elevated C-reactive protein value (CRP). Unfortunately, many of these factors can be negative at clinical presentation, and some studies indicate that these factors are best re- AJR:188, June
2 served for monitoring treatment rather than determining diagnosis [3, 5, 11]. Imaging-guided bone biopsy with CT or fluoroscopy is a useful technique in diagnosing osteomyelitis and is the preferred initial technique for obtaining both histologic and microbiologic samples. This procedure can be performed on an outpatient basis, and complication rates are low [13 15]. For this study, we determined the rate of positive culture in histologically proven cases of osteomyelitis obtained from imagingguided biopsies and identified clinical or technical factors associated with positive or negative culture results. We hypothesized that the culture positivity rate would be low and that certain clinical and technical factors would affect the culture positivity rate. Materials and Methods We performed a retrospective review of 800 consecutive imaging-guided core bone biopsies at two large tertiary care medical centers. Between January 1998 and December 2005, 225 imaging-guided bone biopsies were performed at the first institution and 575 biopsies were performed at the second institution from January 1999 to March Of the 800 total bone biopsies performed under CT or fluoroscopy guidance, 75 patients had samples sent for both histologic and microbiologic analyses. In all 75 patients, osteomyelitis was suspected; however, the level of suspicion varied. In some patients, the diagnosis of osteomyelitis was nearly certain and the biopsy was performed to tailor antibiotic therapy. In other patients, osteomyelitis was very low on the differential and the culture samples were obtained only for diagnostic completeness. Patients referred for imaging-guided biopsies are typically greater diagnostic challenges than those seen at surgery. We did not include spine biopsies in this series because culture positivity rates may be higher in the spine than in the remainder of the skeleton [16, 17]. This study was approved by the institutional review boards of both institutions. Musculoskeletal radiologists at the two institutions obtained samples using standard coaxial bone biopsy techniques [18 20]. Most of the biopsies were performed with either a 15-gauge needle (1.7- mm-diameter bore) (Bonopty, Radi Medical Systems) or a 14-gauge needle (2.03-mm-diameter bore) (Elson/Ackerman, Cook). At the beginning of the procedure, the target lesion was localized under CT or fluoroscopy guidance. Once the patient had received appropriate local anesthetic and was under conscious sedation, a penetration cannula was placed adjacent to the outer cortex of the lesion. Subsequently, a biopsy cannula was used to obtain core bone samples. An average of three samples were obtained at both institutions. Aspiration of the lesion for purulent fluid is attempted during each biopsy. At least one core sample was sent for microbiologic analysis. We defined a positive case of osteomyelitis for this study as a histologic report indicating acute osteomyelitis, chronic osteomyelitis, or acute and chronic osteomyelitis. Cases of acute osteomyelitis showed the presence of acute inflammatory cells, congestion or thrombosis of medullary or periosteal small vessels, and necrotic bone. Cases of chronic osteomyelitis exhibited areas of woven bone and fibrosis with large numbers of lymphocytes, histiocytes, and plasma cells in the absence of neutrophils. Features of both were seen in cases of acute and chronic osteomyelitis. Forty-one of the 75 patients (55%) had a histologic diagnosis of osteomyelitis. For microbiologic analysis, we considered a culture positive if any organism grew. We performed a chart review of the 41 histologically positive cases of osteomyelitis to determine whether the following factors contributed to positive or negative culture results: histologic type of osteomyelitis (acute or chronic), antibiotic therapy before biopsy, fever (temperature 38.0ºC), elevated WBC count ( μl), elevated ESR ( 10 mm/h), elevated CRP value ( 6 mg/l), biopsy needle size, and the amount of purulent fluid obtained at biopsy. For the purposes of this study, histology samples interpreted as acute osteomyelitis or as acute and chronic osteomyelitis were considered to be cases of acute osteomyelitis. A patient was considered to have received antibiotic therapy if any dose was given within 24 hours before the biopsy. Patients at both institutions are asked to discontinue antibiotic therapy for at least 24 hours before biopsy, if feasible. The definition of fever was a temperature of 38.0 C within 7 days of the biopsy. A subject had an elevated WBC count, ESR, or CRP value if the values were elevated at any time from initial presentation to the time of biopsy. We also documented the biopsy needle gauge and the amount of purulent fluid aspirated at biopsy. Analyses were conducted using SAS software (version 8.02, SAS Institute). We calculated p values from the chi-square test or Fisher s exact test for categoric variables and from the Wilcoxon s rank sum test for ordinal or continuous variables. Finally, we compared the histologic and microbiologic data from the surgical biopsy or débridement with the preceding imaging-guided biopsy results. Results Of the 75 cases of suspected osteomyelitis, there were 41 cases of osteomyelitis based on histology, and these 41 cases were retrospectively reviewed. In the remaining 34 cases that were negative for osteomyelitis based on histology, there were four cases with positive culture results. The histologic diagnoses for the 30 remaining cases with negative culture results were metastasis, n=3; lymphoma, n=2; myeloma, n=1; telangiectatic osteosarcoma, n=1; Ewing s sarcoma, n=1; nonossifying fibroma, n =1; Paget s disease, n=1; healing fracture, n=1; and no malignancy or osteomyelitis, n =19. Of the 41 histologically positive cases, 24 patients were male, and the mean age of all 75 patients was 40.8 years with a range of 3 82 years. The results are summarized in Table 1. Of the 41 histologically positive cases of osteomyelitis, 14 (34%) cases were positive at culture. Staphylococcus aureus was the most common organism cultured, detected in eight (57%) of the 14. The culture positivity rate did not vary with patient sex, by type of imaging guidance, or between the two institutions (Table 2). Moreover, no significant difference in the culture positivity rate was seen with regard to acute versus chronic osteomyelitis, antibiotic therapy before biopsy, fever, elevated WBC count, elevated ESR, elevated CRP value, or biopsy needle size (Table 2). Purulent fluid was aspirated in 10 (24%) of the 41 cases and five (50%) of 10 grew an organism at culture (p = 0.22). Of the 31 cases for which no purulent fluid was aspirated at biopsy, only nine (29%) of the 31 cultures were positive. Of the six patients from whom 2 ml of purulent fluid was aspirated, five (83%) had positive culture (p = 0.02) (Table 2). Surgical biopsy or débridement was performed in 10 (24%) of the 41 histologically positive cases of osteomyelitis: four surgeries in patients with positive cultures and six surgeries in patients with negative cultures (Table 3). In nine of the 10 surgical cases, acute or chronic osteomyelitis was the histologic diagnosis, compatible with the imaging-guided biopsy result. In the 10th case, the surgical specimen was nondiagnostic and no histologic result was given; however, the culture specimen was positive. Of the four cases with positive culture results from the imaging-guided biopsy, two grew S. aureus, which is identical to the imaging-guided biopsy culture results. No growth occurred in the other two cases; however, both of these patients received antibiotics during the time interval between the imaging-guided biopsy and the surgical procedure. Of the six culture-negative cases at imaging-guided biopsy that underwent surgery, four cases had no growth at culture similar to the imaging-guided biopsy results. The other two cases grew organisms from the surgical specimen AJR:188, June 2007
3 Imaging-Guided Bone Biopsy for Osteomyelitis TABLE 1: Summary of 41 Patients Undergoing Imaging-Guided Biopsy with Histologically Proven Osteomyelitis Patient Imaging Clinical Finding Age (y) Guidance Used for Biopsy Biopsy Site Type of Osteomyelitis per Histology Results Microbiology Results ABX a Fever b WBC Count c ESR d CRP e Size of Biopsy Needle (gauge) No. Sex 1 M 10 CT Femur Acute 15 2 F 12 CT Pelvis sacrum Acute and chronic 11 3 M 47 CT Rib Acute 15 4 F 13 CT Tibia Chronic 15 5 M 3 CT Pelvis iliac Acute and chronic F 78 CT Pelvis pubic symphysis Acute 15 7 F 82 CT Humerus Acute F 72 CT Pelvis pubic symphysis Acute and chronic F 13 CT Clavicle Chronic F 21 CT Tibia Acute and chronic F 6 CT Tibia Acute and chronic F 73 FL Foot phalanx Chronic M 52 FL Pelvis ischium Chronic M 48 CT Foot calcaneus Acute M 45 FL Foot metatarsal Chronic NA 16 M 30 CT Pelvis iliac Acute F 77 FL Foot phalanx Acute M 76 FL Pelvis coccyx Chronic M 30 CT Pelvis ischium Chronic NA 20 F 41 CT Pelvis sacrum Chronic + NA 1 21 M 20 FL Femur Chronic M 53 CT Sternum Chronic M 41 FL Foot metatarsal Acute M 21 CT Sternum Chronic F 27 FL Pelvis iliac Acute and chronic M 35 CT Fibula Acute M 66 FL Foot metatarsal Chronic M 32 CT Humerus Chronic Staphylococcus aureus M 70 CT Femur Acute S. aureus F 23 CT Tibia Acute S. aureus M 33 FL Pelvis ischium Chronic S. aureus M 30 CT Pelvis ischium Chronic S. aureus M 23 CT Tibia Acute and chronic S. aureus M 66 CT Foot calcaneus Acute S. aureus F 24 CT Pelvis ischium Acute S. aureus M 59 CT Pelvis ischium Chronic Streptococcus viridans, 14 Bacteroides fragilis 37 F 45 CT Radius Acute Salmonella M 17 FL Pelvis ischium Acute and chronic Corynebacterium organisms 39 F 62 FL Foot metatarsal Chronic Corynebacterium organisms 40 M 41 FL Foot metatarsal Chronic Corynebacterium organisms F 54 CT Femur Acute Escherichia coli Note Plus sign (+) indicates present. FL = fluoroscopy, NA = not available. a A patient was considered to have received antibiotics (ABX) if any dose was given within 24 hours before the biopsy. b Fever = temperature 38.0 C within 7 days of the biopsy. c WBC count μl. d Erythrocyte sedimentation rate (ESR) 10 mm/h. e C-reactive protein (CRP) 6 mg/l. Purulent Fluid (ml) AJR:188, June
4 TABLE 2: Culture Positivity Rates (%) for Various Factors in 41 Histologically Positive Cases of Osteomyelitiss Factor Present Absent p Histologic result of osteomyelitis 34 Patient sex Male 38 Female 29 Imaging guidance used for biopsy CT 36 Fluoroscopy 31 Institution 1 31 Institution 2 36 Type of osteomyelitis Acute 35 Chronic 33 Antibiotics administered before biopsy Fever a Elevated WBC count b Elevated ESR c Elevated CRP value d Size of biopsy needle 14-gauge gauge 41 Any purulent fluid aspirated ml of purulent fluid aspirated e a Fever = temperature 38.0 C within 7 days of the biopsy. b WBC count μl. c Erythrocyte sedimentation rate (ESR) 10 mm/h. d C-reactive protein (CRP) 6 mg/l. e Statistically significant difference. Discussion Osteomyelitis is a challenging disease to diagnose and treat given its variable imaging and clinical characteristics. Although the definitive diagnosis of osteomyelitis is made by culturing an organism directly from the site of infection, cultures attained from biopsy and surgery can be negative in 40 60% of cases [5 8]. Only 34% of the histologically positive cases of osteomyelitis were positive at culture in this study. This result is similar to those of other studies [5 7, 11]. White et al. [6] evaluated the utility of sending both histologic and microbiologic biopsy samples and found eight positive cultures in 19 histologically or surgically proven cases of osteomyelitis, for a culture positivity rate of 42%. Similarly Schweitzer et al. [7] found an overall culture positivity rate of 50% for imaging-guided biopsies when evaluating the effect of lidocaine on culture yield in 28 cases of osteomyelitis. The culture positivity rate in the spine may be higher; thus, spinal Culture Positivity Rate (%) in Cases with Factor infection cases were excluded from our study. Chew and Kline [16] found 39 positive cultures of 43 histologically or surgically proven cases of osteomyelitis in the spine. Sampling of adjacent purulent disk material during the vertebral body biopsy was a proposed factor accounting for the high culture-positive rate. Although imaging-guided bone biopsies are relatively safe [13 15], the referring clinician and radiologist should be aware of the low culture positivity rate. Thus, in cases in which the diagnosis of osteomyelitis is obvious, performing a biopsy for the sole purpose of attaining an organism to guide antimicrobial treatment must be performed with caution. This is most important in cases in which the risk of adjacent tissue injury or seeding of noninfected tissue is high. The most common organism found at culture was S. aureus, seen in 57% of the cultures, which is consistent with the results of other studies [1, 11, 16, 21]. Dich et al. [21] evaluated 163 cases of osteomyelitis and found S. aureus to be the most common etiologic agent, seen in 61% of cases. With regard to clinical, laboratory, and biopsy-related factors associated with culture positivity or negativity, we found only one significant association: the aspiration of 2 ml of purulent fluid at biopsy. Histologic type of osteomyelitis (acute or chronic), antibiotic therapy before biopsy, fever, elevated WBC count, elevated ESR, elevated CRP value, and biopsy needle size did not have a significant association with positive or negative cultures. These results have several implications. First, the aspiration of 2 ml of purulent fluid at biopsy was the only factor associated with a higher culture positivity rate. When no purulent fluid was obtained, only 29% of cases were positive at culture. The culture positivity rate increased to 50% if any purulent fluid was aspirated and rose to 83% if 2 ml of purulent fluid was obtained. Intuitively, this finding that culture yield would increase as the amount of organisms obtained at biopsy increases seems reasonable. This finding suggests that performing biopsies in suspected cases of intraosseous or periosseous abscess is useful, especially if the abscess is large. Thus, if fluid collections can be seen on imaging, the culture yield from these biopsies may be higher and may warrant the procedure, especially in more hazardous situations. Second, radiologists commonly request that patients discontinue antimicrobial therapy for at least 24 hours before biopsy to have the highest chance of isolating an organism. Although this difference was not statistically significant, we did detect a lower culture positivity rate in the patients on antimicrobial therapy before biopsy versus the patients off therapy. Of the patients who received antibiotic therapy within 24 hours of the biopsy, 24% had a positive culture, whereas the patients who did not receive antibiotics had a 42% culture positivity rate. Larger prospective studies are needed to further investigate this finding. Given our results, we have maintained our requests to referring clinicians to discontinue antibiotics for at least 24 hours before biopsy. Third, although one may hypothesize that a larger biopsy needle size would lead to a higher likelihood of culture positivity due to a larger sample volume, our results suggest no difference in culture positivity rates between the two predominant needle sizes used, 14- and 15-gauge. Unfortunately, the two main needles used did not differ much in size. Finally, there was good correlation of both the histologic and microbiologic results from 1532 AJR:188, June 2007
5 Imaging-Guided Bone Biopsy for Osteomyelitis TABLE 3: Comparison of Histology and Microbiology Results from Imaging-Guided Biopsy and Surgery Patient Surgical Histology Results for Type of Osteomyelitis at Microbiology Results at No. Sex Age (y) Procedure Biopsy Site Biopsy Surgery Biopsy Surgery 1 M 35 Débridement Fibula Acute Acute and chronic 2 F 12 Débridement Pelvis sacrum Acute and chronic Acute and chronic 3 F 13 Débridement Tibia Chronic Chronic 4 F 21 Débridement Tibia Acute and chronic Acute and chronic 5 M 21 Biopsy Sternum Chronic Nondiagnostic Staphylococcus epidermidis 6 M 10 Débridement Femur Acute Acute Fusobacterium organisms 7 M 32 Débridement Humerus Chronic Acute and chronic Staphylococcus aureus 8 F 23 Débridement Tibia Acute Chronic S. aureus 9 M 23 Débridement Tibia Acute and chronic Acute and chronic S. aureus S. aureus 10 M 70 Biopsy Femur Acute Acute S. aureus S. aureus the imaging-guided biopsies and surgical procedures. Aside from one nondiagnostic surgical specimen, all surgical samples were positive for osteomyelitis and were histologically identical to the imaging-guided biopsy results. In no cases did organisms isolated from the imagingguided biopsy differ with those attained at surgery. These results suggest that imaging-guided bone biopsies are accurate procedures, which is similar to the results of past studies [2, 5, 6, 9]. Despite the strengths of our study, a few limitations deserve mention. Our sample size may not be large enough to detect a significant difference in histologic type of osteomyelitis, antibiotic therapy before biopsy, WBC count, ESR, CRP value, or size of biopsy needle in the groups who had positive and negative cultures. Although osteomyelitis is common, requests for imaging-guided biopsies for osteomyelitis are relatively uncommon. Our study consists of 800 bone biopsies over a 7- and an 8-year period at two large tertiary care centers, with only 75 biopsies performed for suspected osteomyelitis. This is only 3 7 cases per year for each institution. Often patients with clear clinical or laboratory data suggesting osteomyelitis are treated with antibiotics or are taken directly to surgery without undergoing an imagingguided biopsy. For instance, a patient with diabetes who has a draining foot ulcer with exposed bone is unlikely to need imagingguided biopsy to diagnosis osteomyelitis. The cases referred for biopsy are often in patients for whom the diagnosis is difficult. Despite the low numbers, the similar culture positivity rates between the two institutions (31% and 36%) suggest that the 34% combined culture positivity rate is accurate. In addition, the 24-hour antibiotic-free interval used in this study is somewhat arbitrary, considering some patients with chronic renal failure in whom the serum level of antibiotics may be high. Nevertheless, we consider this parameter to be acceptable because it is current practice at both institutions is to discontinue antibiotics at least 24 hours before biopsy. Another limitation of the study pertains to using positive histology as the diagnostic standard in the study. Although this may not be optimal, we are likely underdiagnosing, not overdiagnosing, cases of osteomyelitis. Sampling error will reduce the accuracy of histology by increasing the number of falsenegatives; however, the positive cases at histology are likely true cases of osteomyelitis. The histologic definition of acute osteomyelitis is fairly specific; thus, it is unlikely that there is an alternative diagnosis, such as metastasis or myeloma, if the histologic result is osteomyelitis. Our study focuses on these positive histology cases; thus, we believe using positive histology as the diagnostic standard is reasonable. In conclusion, the rate of positive culture of osteomyelitis obtained from imaging-guided core biopsy is low. We found that aspiration of 2 ml of purulent fluid at biopsy is associated with a higher culture positivity rate. Clinicians and radiologists should be aware that the likelihood of isolating an organism with imagingguided biopsies is low, but it is significantly higher in cases of intraosseous abscesses. Acknowledgment We thank A. C. Wu for statistical support and manuscript review. References 1. Dirckx JH. Stedman s concise medical dictionary for the health professions, 3rd ed. Baltimore, MD: Williams and Wilkins, 1997: Zuluaga AF, Galvis W, Jaimes F, Vesga O. Lack of microbiological concordance between bone and non-bone specimens in chronic osteomyelitis: an observational study. BMC Infect Dis 2002; 2:8 3. Sammak B, Abd El Bagi M, Al Shahed M, et al. Osteomyelitis: a review of currently used imaging techniques. Eur Radiol 1999; 9: Termaat MF, Raijmakers PG, Scholten HJ, Bakker FC, Patka P, Haarman HJ. The accuracy of diagnostic imaging for the assessment of chronic osteomyelitis: a systematic review and meta-analysis. J Bone Joint Surg Am 2005; 87: Howard CB, Einhorn M, Dagan R, Yagupski P, Porat S. Fine-needle bone biopsy to diagnose osteomyelitis. J Bone Joint Surg Br 1994; 76: White LM, Schweitzer ME, Deely DM, Gannon F. Study of osteomyelitis: utility of combined histologic and microbiologic evaluation of percutaneous biopsy samples. Radiology 1995; 197: Schweitzer ME, Deely DM, Beavis K, Gannon F. Does the use of lidocaine affect the culture of percutaneous bone biopsy specimens obtained to diagnose osteomyelitis? An in vitro and in vivo study. AJR 1995; 164: Han H, Lewis VL Jr, Wiedrich TA, Patel PK. The value of Jamshidi core needle bone biopsy in predicting postoperative osteomyelitis in grade IV pressure ulcer patients. Plast Reconstr Surg 2002; 110: Khatri G, Wagner DK, Sohnle PG. Effect of bone biopsy in guiding antimicrobial therapy for osteomyelitis complicating open wounds. Am J Med Sci 2001; 321: Zuluaga AF, Galvis W, Saldarriaga JG, Agudelo M, Salazar BE, Vesga O. Etiologic diagnosis of chronic AJR:188, June
6 osteomyelitis: a prospective study. Arch Intern Med 2006; 166: Jeffcoate WJ, Lipsky BA. Controversies in diagnosing and managing osteomyelitis of the foot in diabetes. Clin Infect Dis 2004; 39[suppl 2]:S115 S Senneville E, Melliez H, Beltrand E, et al. Culture of percutaneous bone biopsy specimens for diagnosis of diabetic foot osteomyelitis: concordance with ulcer swab cultures. Clin Infect Dis 2006; 42: Appelbaum AH, Kamba TT, Cohen AS, Qaisi WG, Amirkhan RH. Effectiveness and safety of imagedirected biopsies: coaxial technique versus conventional fine-needle aspiration. South Med J 2002; 95: Dupuy DE, Rosenberg AE, Punyaratabandhu T, Tan MH, Mankin HJ. Accuracy of CT-guided needle biopsy of musculoskeletal neoplasms. AJR 1998; 171: Hau A, Kim I, Kattapuram S, et al. Accuracy of CTguided biopsies in 359 patients with musculoskeletal lesions. Skeletal Radiol 2002; 31: Chew FS, Kline MJ. Diagnostic yield of CT-guided percutaneous aspiration procedures in suspected spontaneous infectious diskitis. Radiology 2001; 218: Rankine JJ, Barron DA, Robinson P, Millner PA, Dickson RA. Therapeutic impact of percutaneous spinal biopsy in spinal infection. Postgrad Med J 2004; 80: Jelinek JS, Murphey MD, Welker JA, et al. Diagnosis of primary bone tumors with image-guided percutaneous biopsy: experience with 110 tumors. Radiology 2002; 223: Issakov J, Flusser G, Kollender Y, Merimsky O, Lifschitz-Mercer B, Meller I. Computed tomography guided core needle biopsy for bone and soft tissue tumors. Isr Med Assoc J 2003; 5: Ng CS, Salisbury JR, Darby AJ, Gishen P. Radiologically guided bone biopsy: results of 502 biopsies. Cardiovasc Intervent Radiol 1998; 21: Dich VQ, Nelson JD, Haltalin KC. Osteomyelitis in infants and children: a review of 163 cases. Am J Dis Child 1975; 129: AJR:188, June 2007
OSTEOMYELITIS. If it occurs in adults, then the axial skeleton is the usual site.
OSTEOMYELITIS Introduction Osteomyelitis is an acute or chronic inflammatory process of the bone and its structures secondary to infection with pyogenic organisms. Pathophysiology Osteomyelitis may be
More informationJournal of Radiology and Imaging
Journal of Radiology and Imaging An Open Access Publisher http://dx.doi.org/10.14312/2399-8172.2017-2 Original research Open Access Reduction of radiation dose in adult CT-guided musculoskeletal procedures
More informationOsteomyelitis in infancy and childhood: A clinical and diagnostic overview M. Mearadji
Osteomyelitis in infancy and childhood: A clinical and diagnostic overview M. Mearadji International Foundation for Pediatric Imaging Aid Introduction Osteomyelitis is a relative common disease in infancy
More informationINFECTION & INFLAMMATION IMAGING
INFECTION & INFLAMMATION IMAGING Radiopharmaceutical Drug Interactions & Other Interesting Case Studies MICHELLE RUNDIO, CNMT NCT MBA PCI NUCLEAR IN-111 WHITE BLOOD CELL IMAGING Interactions, Imaging Parameters
More informationMusculoskeletal Imaging Original Research
Musculoskeletal Imaging Original Research Musculoskeletal Imaging Original Research Connie Y. Chang 1 F. Joseph Simeone 1 Sandra B. Nelson 2 Atul K. Taneja 3 Ambrose J. Huang 1 Chang CY, Simeone FJ, Nelson
More informationUtility of Repeat Core Needle Biopsy of Musculoskeletal Lesions With Initially Nondiagnostic Findings
Musculoskeletal Imaging Original Research Repeat Core Needle Biopsy of Initially Nondiagnostic Musculoskeletal Lesions Musculoskeletal Imaging Original Research JOURNAL CLUB Jim S. Wu 1 Colm J. McMahon
More informationChronic recurrent multifocal osteomyelitis (CRMO) advancing the diagnosis
Roderick et al. Pediatric Rheumatology (2016) 14:47 DOI 10.1186/s12969-016-0109-1 SHORT REPORT Chronic recurrent multifocal osteomyelitis (CRMO) advancing the diagnosis M. R. Roderick 1,2*, R. Shah 2,
More informationUtility of magnetic resonance imaging in the follow-up of children affected by acute osteomyelitis.
Curr Pediatr Res 017; 1 (): 354-358 ISSN 0971-903 www.currentpediatrics.com Utility of magnetic resonance imaging in the follow-up of children affected by acute osteomyelitis. Valentina Fabiano 1, Giulia
More informationPercutaneous Fluoroscopic Synovial Biopsy as a New Diagnostic Test for Periprosthetic Infection after Shoulder Arthroplasty: A Feasibility Study
Percutaneous Fluoroscopic Synovial Biopsy as a New Diagnostic Test for Periprosthetic Infection after Shoulder Arthroplasty: A Feasibility Study J Quon, K Hynes, P Lapner, A Sheikh The Ottawa Hospital
More informationCase Report Sacral Emphysematous Osteomyelitis Caused by Escherichia coli after Arthroscopy of the Knee
Case Reports in Orthopedics Volume 2016, Article ID 1961287, 4 pages http://dx.doi.org/10.1155/2016/1961287 Case Report Sacral Emphysematous Osteomyelitis Caused by Escherichia coli after Arthroscopy of
More informationDiagnostic and Complication Rate of Image-guided Lung Biopsies in Raigmore Hospital, Inverness: A Retrospective Re-audit
Page1 Original Article NJR 2011;1(1):1 7;Available online at www.nranepal.org Diagnostic and Complication Rate of Image-guided Lung Biopsies in Raigmore Hospital, Inverness: A Retrospective Re-audit S
More informationMARK D. MURPHEY MD, FACR. Physician-in-Chief, AIRP. Chief, Musculoskeletal Imaging
ALPHABET SOUP AND CYSTIC LESIONS OF THE BONE MARK D. MURPHEY MD, FACR Physician-in-Chief, AIRP Chief, Musculoskeletal Imaging ALPHABET SOUP AND CYSTIC LESIONS OF THE BONE Giant cell tumor (GCT) Unicameral
More informationThe Radiology Assistant : Bone tumor - ill defined osteolytic tumors and tumor-like lesions
Bone tumor - ill defined osteolytic tumors and tumor-like lesions Henk Jan van der Woude and Robin Smithuis Radiology department of the Onze Lieve Vrouwe Gasthuis, Amsterdam and the Rijnland hospital,
More informationTopics. Musculoskeletal Infection Extremities. Detection of Infection. Role of Imaging in Extremity Infection. Detection of Infection
Topics Musculoskeletal Infection Extremities Nuttaya Pattamapaspong M.D. Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand Role of imaging in extremity infection
More informationClinical Study Primary Malignant Tumours of Bone Following Previous Malignancy
Sarcoma Volume 2008, Article ID 418697, 4 pages doi:10.1155/2008/418697 Clinical Study Primary Malignant Tumours of Bone Following Previous Malignancy J. T. Patton, S. M. M. Sommerville, and R. J. Grimer
More informationBONES & JOINTS INFECTION BONE TUMOURS
BONES & JOINTS INFECTION BONE TUMOURS IMPORTANT SERIOUS CONSEQUENCE PLEASE DON T MISS!! EARLY DIAGNOSIS & PROPER TREATMENT HOW?? AWARE of THEIR EXISTENCE (Knowledge) PREPARE for THEIR OCCURRENCE A HIGH
More informationESPID New Bone and Joint Infection Guidelines
ESPID New Bone and Joint Infection Guidelines Theoklis Zaoutis, MD, MSCE Professor of Pediatrics and Epidemiology Perelman School of Medicine at the University of Pennsylvania Chief, Division of Infectious
More informationNuclear medicine and Prosthetic Joint Infections
Nuclear medicine and Prosthetic Joint Infections Christophe Van de Wiele, M.D., Ph.D. Department of Nuclear Medicine, University Hospital Ghent, Belgium Orthopedic prostheses: world market 1996 Prosthetic
More informationEffective local and systemic therapy is necessary for the cure of Ewing tumor Most chemotherapy regimens are a combination of cyclophosphamide,
Ewing Tumor Perez Ewing tumor is the second most common primary tumor of bone in childhood, and also occurs in soft tissues Ewing tumor is uncommon before 8 years of age and after 25 years of age In the
More informationPressure Injury Complications: Diagnostic Dilemmas
Pressure Injury Complications: Diagnostic Dilemmas Aimée D. Garcia, MD, CWS, FACCWS Associate Professor, Department of Medicine, Geriatrics Section Baylor College of Medicine Medical Director, Wound Clinic
More informationAPMA 2018 Radiology Track Bone Tumors When to say Gulp!
APMA 2018 Radiology Track Bone Tumors When to say Gulp! DANIEL P. EVANS, DPM, FACFAOM Professor, Department of Podiatric Medicine and Radiology Dr. Wm. Scholl College of Podiatric Medicine Conflict of
More informationBacteriological Profile of Post Traumatic Osteomyelitis in a Tertiary Care Centre
International Journal of Current Microbiology and Applied Sciences ISSN: 2319-7706 Volume 6 Number 1 (2017) pp. 367-372 Journal homepage: http://www.ijcmas.com Original Research Article http://dx.doi.org/10.20546/ijcmas.2017.601.044
More informationMalignant Bone Tumours. PathoBasic, Daniel Baumhoer
Malignant Bone Tumours PathoBasic, 20.03.18 Daniel Baumhoer FNCLCC Grading The differentiation score is defined as the extent to which a tumor resembles adult mesenchymal tissue (score 1), the extent to
More informationImaging of white blood cells with Scintimun
Imaging of white blood cells with Scintimun APRAMEN Réunion, Mardi 8 février 2011, Paris Wolf S. Richter SCINTIMUN : IgG1 antibody targeting white blood cells Tc-99m kit; murine IgG1 antibody target: NCA-95
More informationInfections have been and will always serve as one of
Neurosurg Focus 37 (2):E10, 2014 AANS, 2014 Computed tomography guided percutaneous biopsy for vertebral osteomyelitis: a department s experience Vasant Garg, M.D., Christos Kosmas, M.D., Peter C. Young,
More informationSarcomas are a heterogeneous group of uncommon tumors
ORIGINAL ARTICLE Chest Wall Sarcomas are Accurately Diagnosed by Image-Guided Core Needle Biopsy Puja Kachroo, MD,* Peter S. Pak, MD,* Harpavan S. Sandha, MD,* Scott D. Nelson, MD, Leanne L. Seeger, MD,
More informationMRI Non-Joint Extremity Questionnaire
MRI n-joint Extremity Questionnaire INSTRUCTIONS FOR COMPLETING QUESTIONNAIRE: Answer all of the initial questions (Pages 1 and 2) Select the reason for imaging by answering question #6. Based on your
More informationBone and Joint Infections in Diabetics: Diagnosis and Management of Diabetic Foot and Other Common Lower Extremity Infections
Bone and Joint Infections in Diabetics: Diagnosis and Management of Diabetic Foot and Other Common Lower Extremity Infections Objectives How do you to diagnose, classify and manage DFI? How do you diagnose
More informationProf. Dr. NAGUI M. ABDELWAHAB,M.D.; MARYSE Y. AWADALLAH, M.D. AYA M. BASSAM, Ms.C.
Role of Whole-body Diffusion MR in Detection of Metastatic lesions Prof. Dr. NAGUI M. ABDELWAHAB,M.D.; MARYSE Y. AWADALLAH, M.D. AYA M. BASSAM, Ms.C. Cancer is a potentially life-threatening disease,
More informationAnesthesia Cross Coder. Essential links from CPT codes to ICD-9-CM and HCPCS codes
Anesthesia Cross Coder Essential links from CPT codes to ICD-9-CM and HCPCS codes 2015 Contents Introduction... i CPT Anesthesia to Procedure Crosswalk...i Format...i Icon Key...ii CPT Codes...ii Resequenced
More informationSMALL ROUND BLUE CELL LESION OF BONE
DISCLOSURE SMALL ROUND BLUE CELL LESION OF BONE Dr. Alistair Jordan University of South Alabama No financial support or endorsement OBJECTIVES Describe the more common small round cell lesions of bone
More informationPercutaneous Lung Biopsy in the Molecular Profiling Era: A Survey of Current Practices
Percutaneous Lung Biopsy in the Molecular Profiling Era: A Survey of Current Practices PHILLIP GUICHET, B.A. 1, FEREIDOUN ABTIN, M.D. 2, CHRISTOPHER LEE, M.D. 1 1 KECK SCHOOL OF MEDICINE OF USC, DEPT OF
More informationPercutaneous Needle Aspiration Biopsy (PCNA) of Pulmonary Lesions: Evaluation of a Reaspiration or a Rebiopsy (second PCNA) 1
Percutaneous Needle Aspiration Biopsy (PCNA) of Pulmonary Lesions: Evaluation of a Reaspiration or a Rebiopsy (second PCNA) 1 In Jae Lee, M.D., Dong Gyu Kim, M.D. 2, Ki-Suck Jung, M.D. 2, Hyoung June Im,
More informationSpecial Imaging MUSCULOSKELETAL INFECTION. Special Imaging. Special Imaging. 18yr old male pt What is it? Additional Imaging
MUSCULOSKELETAL INFECTION Additional Imaging May assist in diagnosis and, possibly, treatment Help create the picture May help differentiate from neoplasia 18yr old male pt What is it? Lymphoma Ewings
More informationSKELETAL STRUCTURES Objectives for Exam #1: Objective for Portfolio #1: Part I: Skeletal Stations Station A: Bones of the Body
SKELETAL STRUCTURES Objectives for Exam #1: 1. Provide information on the various structures and functions of the skeletal system. 2. Describe various skeletal system disorders, including imaging techniques
More informationThe role of Imaging in Ewing sarcoma
The role of Imaging in Ewing sarcoma Poster No.: P-0109 Congress: ESSR 2014 Type: Educational Poster Authors: D. Beomonte Zobel, C. Dell'atti, M. Bartocci, V. Martinelli, N. 1 2 2 2 1 1 1 2 Magarelli,
More informationInfection. Arthrocentesis: Cell count Differential Culture. Infection and associated microorganism(s) confirmed
Painful joint History and examination Radiograph of affected joint Erythrocyte sedimentation rate C-reactive protein Infection No infection suspected Arthrocentesis: Cell count Differential Culture Stop
More informationCOPYRIGHT 2004 BY THE JOURNAL OF BONE AND JOINT SURGERY, INCORPORATED
84 COPYRIGHT 2004 BY THE JOURNAL BONE AND JOINT SURGERY, INCORPORATED Radiographic Evaluation of Pathological Bone Lesions: Current Spectrum of Disease and Approach to Diagnosis BY BENJAMIN G. DOMB, MD,
More informationLate Infection of Spinal Instrumentation
Abstract Late Infection of Spinal Instrumentation Jae-Ik Shim, M.D., Taik-Seon Kim, M.D., Sung-Jong Lee, M.D., Suk-Ha Lee, M.D., Dong-Ki Lee, M.D., Yoen-Sik Yu, M.D., Yun-Yeup Kim, M.D. Department of Orthopaedic
More informationBiopsy. DR. K.B.PRABHUDEV Consultant Orthopedic surgeon Bone And Soft Tissue Tumor Services Sparsh Hospital. Bone Bangalore
Biopsy DR. K.B.PRABHUDEV Consultant Orthopedic surgeon Bone And Soft Tissue Tumor Services Sparsh Hospital Biopsy Biopsy is a critical procedure in the treatment of muskuloskeletal tumors. Biopsy is a
More informationDisclosures! Infection & Nonunions. Infection workup. Skip early infection. Culture (+) fractures. Gross Infection
The Infected Nonunion Paul Tornetta III, MD Professor Boston Medical Center Disclosures! Publications: Rockwood and Green, Tornetta and Ricci TIFS, Tornetta and Einhorn; Subspecialty series, Court-Brown,
More informationOsteomyelitis is an uncommon but potentially. Success of Short-Course Parenteral AntibioticTherapy for Acute Osteomyelitis of Childhood
Success of Short-Course Parenteral AntibioticTherapy for Acute Osteomyelitis of Childhood Clinical Pediatrics Volume 46 Number 1 January 2007 30-35 2007 Sage Publications 10.1177/0009922806289081 http://clp.sagepub.com
More informationInfectious spondylitis is a rare disease that may cause severe. Diagnostic Yield of Fluoroscopy-Guided Biopsy for Infectious Spondylitis
ORIGINAL RESEARCH SPINE Diagnostic Yield of Fluoroscopy-Guided Biopsy for Infectious Spondylitis B.J. Kim, J.W. Lee, S.J. Kim, G.Y. Lee, and H.S. Kang ABSTRACT BACKGROUND AND PURPOSE: CT is currently the
More informationAPPROPRIATE USE GUIDELINES
APPROPRIATE USE GUIDELINES Appropriateness of Advanced Imaging Procedures (MRI, CT, Bone Scan/PET) in Patients with Neck Pain CDI QUALITY INSTITUTE: PROVIDER LED ENTITY (PLE) Updated June, 2017 Contents
More informationGeneral Approach to Lytic Bone Lesions D. Lee Bennett, MD, MA, Georges Y. El Khoury, MD Appl Radiol. 2004;33(5)
General Approach to Lytic Bone Lesions D. Lee Bennett, MD, MA, Georges Y. El Khoury, MD Appl Radiol. 2004;33(5) www.medscape.com Abstract and Introduction Abstract When interpreting musculoskeletal radiographs,
More informationTUBERCULOSIS OF THE RIB IN A 20 MONTH S OLD BOY
CASE REPORT TUBERCULOSIS OF THE RIB IN A 20 MONTH S OLD BOY El Mouhtadi Aghoutane, Tarik Salama, Redouane El Fezzazi Pediatric surgery department, Kadi Ayyad University, Marrakech, Morocco Abstract Primary
More informationIliac aneurysmal bone cyst treated by cystoscopic controlled curettage
Accepted February 13th, 2004 Iliac aneurysmal bone cyst treated by cystoscopic controlled curettage Ludwig Schwering¹, Markus Uhl² and Georg W. Herget( )¹ ¹ Department of Orthopaedics and Traumatology,
More informationJOURNAL OF INTERNATIONAL ACADEMIC RESEARCH FOR MULTIDISCIPLINARY Impact Factor 2.417, ISSN: , Volume 3, Issue 11, December 2015
MANAGEMENT OF PATHOLOGICAL FRACTURE SHAFT HUMERUS SECONDARY TO BACTERIAL OSTEOMYELITIS: A CASE REPORT DR. NARENDRA SINGH KUSHWAHA* DR.SHAH WALIULLAH** DR.VINEET KUMAR*** DR.VINEET SHARMA**** *Asst. Professor,
More informationP-1 (Former P-1) Are pediatric patients on oral or intravenous steroids at an increased risk of developing septic arthritis?
Pediatrics Prevention P-1 (Former P-1) Are pediatric patients on oral or intravenous steroids at an increased risk of developing septic arthritis? RESEARCHED BY: Muhammad Amin Chinoy MD, Pakistan Literature:
More informationCT-Guided Biopsy of Bone: A Radiologist s Perspective
Musculoskeletal Imaging Pictorial Essay Espinosa et al. CT-Guided one iopsy Musculoskeletal Imaging Pictorial Essay Leandro. Espinosa 1 David. Jamadar 1 Jon. Jacobson 1 Michel O. DeMaeseneer 2 Farhad S.
More informationOsteomieliti STEOMIE
OsteomielitiSTEOMIE Osteomyelitis is the inflammation of bone caused by pyogenic organisms. Major sources of infection: - haematogenous spread - tracking from adjacent foci of infection - direct inoculation
More informationThe Skeletal System. Mosby items and derived items 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
The Skeletal System Functions of Skeletal System Provides internal framework that supports the body Protects internal organs Helps fight disease by producing white blood cells 2 Functions of Skeletal System
More informationThe Skeletal System. Chapter 7a. Skeletal System Introduction Functions of the skeleton Framework of bones The skeleton through life
The Skeletal System Skeletal System Introduction Functions of the skeleton Framework of bones The skeleton through life Chapter 7a Support Protection Movement Storage areas Minerals Lipids Hemopoiesis
More informationProf Oluwadiya KS FMCS (Orthop) Consultant Orthopaedic Surgeon / Associate Professor Division of Orthopaedics and Traumatology Department of Surgery
Prof Oluwadiya KS FMCS (Orthop) Consultant Orthopaedic Surgeon / Associate Professor Division of Orthopaedics and Traumatology Department of Surgery College of Health Sciences Ladoke Akintola University
More informationMATERIALS AND METHODS. We retrospectively reviewed a consecutive series
Huanqi Li1 Phillip M. Boiselle1 2 Jo-Anne 0. Shepard1 Beatrice Trotman-Dickenson1 Theresa C. McLoud1 Received January 2, 1996; accepted after revision Febru ary 19, 1996. tchest Division, Department of
More informationDisseminated Primary Non-Hodgkin s Lymphoma of Bone : A Case Re p o r t 1
Disseminated Primary Non-Hodgkin s Lymphoma of Bone : A Case Re p o r t 1 Hee-Jin Park, M.D., Sung-Moon Lee, M.D., Hee-Jung Lee, M.D., Jung-Sik Kim, M.D., Hong Kim, M.D. Primary lymphoma of bone is uncommon
More informationCierny-Mader classification of chronic osteomyelitis: Preoperative evaluation with cross-sectional imaging
Cierny-Mader classification of chronic osteomyelitis: Preoperative evaluation with cross-sectional imaging Poster No.: C-590 Congress: ECR 2009 Type: Topic: Educational Exhibit Musculoskeletal Authors:
More informationCT-guided biopsy in suspected spondylodiscitis: microbiological yield, impact on antimicrobial treatment, and relationship with outcome
Skeletal Radiology (2018) 47:1383 1391 https://doi.org/10.1007/s00256-018-2944-2 SCIENTIFIC ARTICLE CT-guided biopsy in suspected spondylodiscitis: microbiological yield, impact on antimicrobial treatment,
More informationReview Course «Musculoskeletal Oncology» October 6, 2011 UNIKLINIK BALGRIST. Imaging of Bone and Soft Tissue. Tumors
Imaging of Bone and Soft Tissue Tumors Approach from a radiologist s point of view Florian Buck Radiology Radio- Radio- Oncologist Oncologist Orthopedist Orthopedist Patient Management Oncologist Oncologist
More informationMusculoskeletal Radiology
Musculoskeletal Radiology Hong Kong College of Radiologists MS 1 Acute osteomyelitis Acute osteomyelitis Plain radiographs reviewed Spine Other bones MRI Acute osteomyelitis diagnosed Acute osteomyelitis
More informationImplementing a Standardized Radiograph and MRI Reporting System for Suspected Pedal Osteomyelitis
Implementing a Standardized Radiograph and MRI Reporting System for Suspected Pedal Osteomyelitis Broering GH, MD LiawSC, MD PalischAR, MD Willis MH, DO Our project utilized the Institute for Healthcare
More informationChapter 5 The Skeletal System
Chapter 5 The Skeletal System The Skeletal System Parts of the skeletal system Bones (skeleton) Joints Cartilages Ligaments (bone to bone)(tendon=bone to muscle) Divided into two divisions Axial skeleton:
More informationAcute Osteomyelitis: similar to septic arthritis but up to 40% may be afebrile swelling overlying the bone & tenderness
Osteomyelitis / Bone and Joint Infections Bone infections in children are usually from haematogenous bacterial seeding to a single joint, usually the lower limbs, but may be multifocal. Approximately 10%
More informationInfection Imaging In Nuclear Medicine: Arguing The Case for PET/CT.
Infection Imaging In Nuclear Medicine: Arguing The Case for PET/CT. LUIS A. TAMARA M.D. NUCLEAR MEDICINE /PET-CT SERVICE CHIEF MEDVAMC DISCLOSURES. 2 3 Not difficult to appreciate the difference! GA-67
More informationSEPTIC ARTHRITIS. Dr Ahmed Husam Al Ahmed Rheumatologist SYRIA. University of Science and technology Hospital Sanaa Yemen 18/Dec/2014
SEPTIC ARTHRITIS Dr Ahmed Husam Al Ahmed Rheumatologist SYRIA University of Science and technology Hospital Sanaa Yemen 18/Dec/2014 Objectives be able to define Septic Arthritis know what factors predispose
More informationMRI of Diabetic foot - appearances and mimics, a pictorial review
MRI of Diabetic foot - appearances and mimics, a pictorial review Poster No.: C-0526 Congress: ECR 2012 Type: Educational Exhibit Authors: R. Dutta, M. George; Singapore/SG Keywords: Musculoskeletal joint,
More informationBone Tumors Clues and Cues
William Herring, M.D. 2002 Bone Tumors Clues and Cues In Slide Show mode, advance the slides by pressing the spacebar All Photos Retain the Copyright of their Authors Clues by Appearance of Lesion Patterns
More informationThe Frequency and Significance of Small (15 mm) Hepatic Lesions Detected by CT
535 Elizabeth C. Jones1 Judith L. Chezmar Rendon C. Nelson Michael E. Bernardino Received July 22, 1991 ; accepted after revision October 16, 1991. Presented atthe annual meeting ofthe American Aoentgen
More informationA Patient s Guide to Limping in Children
A Patient s Guide to Limping in Children 651 Old Country Road Plainview, NY 11803 Phone: 5166818822 Fax: 5166813332 p.lettieri@aol.com DISCLAIMER: The information in this booklet is compiled from a variety
More informationInteresting Case Series. Pyogenic (Suppurative) Flexor Tenosynovitis: Assessment and Management
Interesting Case Series Pyogenic (Suppurative) Flexor Tenosynovitis: Assessment and Management Renee L. Barry, BS a,nicholass.adams,md a,b, and Matthew D. Martin, MD a,b,c a Michigan State University College
More informationAntibiotic Management of Pediatric Osteomyelitis
Reprinted from www.antimicrobe.org Sandra Arnold, M.D. Antibiotic Management of Pediatric Osteomyelitis Several points uncertainty exist regarding the antimicrobial management of acute hematogenous osteomyelitis,
More informationDiskitis Joseph Junewick, MD FACR
Diskitis Joseph Junewick, MD FACR 09/20/2010 History 2 year old with fever, back pain and elevated sedimentation rate. Diagnosis Diskitis Discussion Diskitis is an inflammatory process of the intervertebral
More informationMRI findings in proven Mycobacterium tuberculosis (TB) spondylitis
CASE ORIGINAL REPORT ARTICLE MRI findings in proven Mycobacterium tuberculosis (TB) spondylitis D J Kotzé, MB ChB L J Erasmus, MB ChB Department of Diagnostic Radiology, University of the Free State, Bloemfontein
More informationThe Radiology Assistant : Bone tumor - well-defined osteolytic tumors and tumor-like lesions
Bone tumor - well-defined osteolytic tumors and tumor-like lesions Henk Jan van der Woude and Robin Smithuis Radiology department of the Onze Lieve Vrouwe Gasthuis, Amsterdam and the Rijnland hospital,
More informationMammographic features and correlation with biopsy findings using 11-gauge stereotactic vacuum-assisted breast biopsy (SVABB)
Original article Annals of Oncology 14: 450 454, 2003 DOI: 10.1093/annonc/mdh088 Mammographic features and correlation with biopsy findings using 11-gauge stereotactic vacuum-assisted breast biopsy (SVABB)
More informationMRI XR, CT, NM. Principal Modality (2): Case Report # 2. Date accepted: 15 March 2013
Radiological Category: Musculoskeletal Principal Modality (1): Principal Modality (2): MRI XR, CT, NM Case Report # 2 Submitted by: Hannah Safia Elamir, D.O. Faculty reviewer: Naga R. Chinapuvvula, M.D.
More informationLab Exercise #04 The Skeletal System Student Performance Objectives
Lab Exercise #04 The Skeletal System Student Performance Objectives The material that you are required to learn in this exercise can be found in either the lecture text or the supplemental materials provided
More informationPercutaneous Antibiotic Delivery Technique (PAD-T) New Concepts in Osteomyelitis Treatment with Long-term Outcomes
New Concepts in Osteomyelitis Treatment with Long-term Outcomes Jeffrey C. Karr DPM, CWS, ABLES, FAPWCA, FCCWS Founder, Central Florida Limb Salvage Alliance Chairman, Founder: The Osteomyelitis Center
More informationInteresting Case Series. Ganglion Cyst of the Peroneus Longus
Interesting Case Series Ganglion Cyst of the Peroneus Longus Andrew A. Marano, BA, Paul J. Therattil, MD, Dare V. Ajibade, MD, PhD, MPH, and Ramazi O. Datiashvili, MD, PhD Division of Plastic and Reconstructive
More informationChapter 6 & 7 The Skeleton
Chapter 6 & 7 The Skeleton Try this Make clockwise circles with your RIGHT foot, while doing this, draw the number 6 in the air with you RIGHT hand what happens to your foot???? Bony Background Adult body
More informationACUTE AND CHRONIC OSTEOMYELITIS
ACUTE AND CHRONIC OSTEOMYELITIS DEFINITION Inflammation of the bone caused by an infecting organism HISTORY In the early 1900 s about 20% of patients with osteomyelitis died and patients who survived had
More informationMohammad Ashraf. - Bahaa Najjar. - Mousa Al-Abbadi. 1 P a g e
- 4 - Mohammad Ashraf - Bahaa Najjar - Mousa Al-Abbadi 1 P a g e Fractures (cont d). Healing of fractures: There are a lot of factors determine the proper healing of the fracture. For example: Displaced
More informationIntraosseous hemangioma is an uncommon benign
Case Report 71 An Intraosseous Capillary Hemagioma Of The Foot In A Child Kah-Wai Ngan, MD; Hui-Ling Hsu 1, MD; Shir-Hwa Ueng, MD An 8-year-old boy presented with an osteolytic lesion at the fourth metatarsal
More informationISPUB.COM. Spectrum Of MRI Findings In Musculoskeletal Tuberculosis: Pictoral Essay. P Chudgar INTRODUCTION SPINE
ISPUB.COM The Internet Journal of Radiology Volume 8 Number 2 Spectrum Of MRI Findings In Musculoskeletal Tuberculosis: Pictoral Essay P Chudgar Citation P Chudgar.. The Internet Journal of Radiology.
More informationAilyn T. Isais-Agdeppa, MD*, Lulu Bravo, MD*
A FIVE-YEAR RETROSPECTIVE STUDY ON THE COMMON MICROBIAL ISOLATES AND SENSITIVITY PATTERN ON BLOOD CULTURE OF PEDIATRIC CANCER PATIENTS ADMITTED AT THE PHILIPPINE GENERAL HOSPITAL FOR FEBRILE NEUTROPENIA
More informationPneumothorax Post CT-guided Fine Needle Aspiration Biopsy for Lung Nodules: Our Experience in King Hussein Medical Center
Pneumothorax Post CT-guided Fine Needle Aspiration Biopsy for Lung Nodules: Our Experience in King Hussein Medical Center Ala Qayet MD*, Laith Obaidat MD**, Mazin Al-Omari MD*, Ashraf Al-Tamimi MD^, Ahmad
More informationNervous & Skeletal Systems. Virtual Science University
Nervous & Skeletal Systems Virtual Science University 1 Nervous & Skeletal Systems Texas TEK B.10(A) The student will interpret the function of systems in organisms (humans) including the nervous and skeletal
More informationAbstract. Introduction. Salah Abobaker Ali
Sensitivity and specificity of combined fine needle aspiration cytology and cell block biopsy versus needle core biopsy in the diagnosis of sonographically detected abdominal masses Salah Abobaker Ali
More informationOsteomyelitis (Inflammation of the Bone and Bone Marrow) Basics
Osteomyelitis (Inflammation of the Bone and Bone Marrow) Basics OVERVIEW Sudden (acute) or long-term (chronic) inflammation of bone and its associated soft-tissue elements of bone marrow, endosteum (lining
More informationOsteoporosis. Dr. C. C. Visser. MBChB MMed (Med Phys) Diploma Musculoskeletal Medicine (UK) Member: Society of Orthopaedic Medicine (UK)
Osteoporosis Dr. C. C. Visser MBChB MMed (Med Phys) Diploma Musculoskeletal Medicine (UK) Member: Society of Orthopaedic Medicine (UK) Effect of age on trabecular bone. Fatfree dry bone cylinders obtained
More informationWhat s Your Diagnosis? Catherine Donewald, Class of 2016
What s Your Diagnosis? Catherine Donewald, Class of 2016 Signalment: 9 ½ year old, male castrate Greyhound dog History: The patient presented to referring veterinarian with a history of decreased energy
More informationTreatment for sternoclavicular joint infections: a multi-institutional study
Original Article Treatment for sternoclavicular joint infections: a multi-institutional study Allen Murga, Hannah Copeland, Rachel Hargrove, Jason M. Wallen, Salman Zaheer Department of Thoracic and Cardiovascular
More informationA peculiar location of a rare bone tumor: sternal lipoma
A peculiar location of a rare bone tumor: sternal lipoma Poster No.: P-0033 Congress: ESSR 2016 Type: Authors: Keywords: DOI: Scientific Poster Z. Akkaya, C. Uzun, S. Enon, G. Kocaman, G. Sahin; Ankara/TR
More informationAlthough acute hematogenous osteomyelitis
Group A -Hemolytic Streptococcal Osteomyelitis in Children Ekopimo O. Ibia, MD, MPH* ; Menfo Imoisili, MD, MPH* ; and Andreas Pikis, MD* ABSTRACT. Objective Little attention has been given to acute hematogenous
More informationService: Imaging. Vertebroplasty. Exceptional healthcare, personally delivered
Service: Imaging Exceptional healthcare, personally delivered Your Doctor has requested that you have a vertebroplasty. We hope the following information will answer some of the questions you may have
More informationHuman Skeletal System Glossary
Acromegaly Apatite Acromegaly - is a condition which involves excessive growth of the jaw, hands, and feet. It results from overproduction of somatotropin in adults (after fusion of the ossification centres
More information10/12/2010. Upper Extremity. Pectoral (Shoulder) Girdle. Clavicle (collarbone) Skeletal System: Appendicular Skeleton
Skeletal System: Appendicular Skeleton Pectoral girdle Pelvic girdle Upper limbs Lower limbs 8-1 Pectoral (Shoulder) Girdle Consists of scapula and clavicle Clavicle articulates with sternum (Sternoclavicular
More informationSkeletal Radiology. Solitary (unicameral) bone cyst. The fallen fragment sign revisited
Skeletal Radiol (1989) 18:261-265 Skeletal Radiology Solitary (unicameral) bone cyst The fallen fragment sign revisited S. Struhl, M.D., C. Edelson, M.D., H. Pritzker, M.D., L.P. Seimon, M.D., and H.D.
More informationContiguous Spinal Metastasis Mimicking Infectious Spondylodiscitis 감염성척추염과유사하게보였던연속적척추전이의증례
Case Report pissn 1738-2637 / eissn 2288-2928 http://dx.doi.org/10.3348/jksr.2015.73.6.408 감염성척추염과유사하게보였던연속적척추전이의증례 Chul-Min Lee, MD 1, Seunghun Lee, MD 1 *, Jiyoon Bae, MD 2 1 Department of Radiology,
More informationApplications of PET/CT in Rheumatology. Role of PET/CT. Annibale Versari, MD Nuclear Medicine PET Center S.Maria Nuova Hospital Reggio Emilia Italy
CME Session Associazione Italiana di Medicina Nucleare ed Imaging Molecolare Applications of PET/CT in Rheumatology Role of PET/CT Annibale Versari, MD Nuclear Medicine PET Center S.Maria Nuova Hospital
More information