Infection of Bone and Joint in X-ray

Osteomyelitis

Route of infection :

1. Direct infection
2. Paracellular spread
3. Hematogenous spread
• Neonate & Infant   มักเป็นทั้ง Epiphysis และ Metaphysis
• Children               มักเป็นแค่เพียง Metaphysis
• Adult                   มักเป็นแ่ค่เพียง Epiphysis

Acute osteomyelitis

• Finding :
• Day 3    : Soft tissue swelling with obliteration of tissue plane
• Day 7+ : Intramedullary bone destruction, Periosteal reaction, Cortical resorption, Endosteal scalloping

Subacute osteomyelitis

• Finding : Well-defined radiolucent area with surrounding sclerosis

Chronic osteomyelitis

• Finding : Radiopaque bony spicule surround (Sequestrum) surrounding with radiolucent area (Granulation tissue).

Pyogenic septic arthritis

• Monoarticular involvement
• Location : M/C @ Knee (all), Hip (Child & Infant)
• Finding :
• Soft tissue swelling
• Synovial membrane thickening
• Cartilage destruction ==> Joint space narrowing
• Bony destruction
• Fibrous/Bony ankylosing

 

Tuberculous infection

Tuberculous spondylitis (M/C form)

• Location : M/C @ L1 spine (มักกินมากกว่า 1 ข้อ)
• Finding : 
• Anterior aspect of vertebral body destruction
• Involving supero-inferior axis
• Involving laterally ==> Psoas abscess
• Vertebral body collapse ==> Gibbous deformity***

Tuberculous Osteomyelitis

• เกิดจาก Hematogenous spread
• Location : M/C @ Pelvis, Long bone, Hand&Foot (Dactylitis)
• Finding :
• Ill-defined osteolytic lesion + Sclerosis
• Well-defined radiolucent lesion (Cystic type)

Tuberculous arthritis

• มักเกิดตามหลัง ostemyelitis
• Location : Large joint
• Finding : "Phemister's triad"
• Juxta-articular osteoporosis
• Marginal erosion
• Joint space narrowing