Orthopedics Book


Osteomyelitis XRay

Aka: Osteomyelitis XRay, Osteomyelitis Plain Radiography, XRay in Suspected Osteomyelitis
  1. See Also
    1. Osteomyelitis MRI
    2. Osteomyelitis CT
    3. Osteomyelitis Bone Scan
    4. Osteomyelitis
    5. Osteomyelitis Causes
    6. Acute Osteomyelitis
    7. Chronic Osteomyelitis
    8. Vertebral Osteomyelitis
    9. Diabetic Foot Osteomyelitis
    10. Suspected Osteomyelitis in Diabetes Mellitus
  2. Indications
    1. First line study in Osteomyelitis evaluation due to low cost and high availability
    2. Narrows Osteomyelitis differential diagnosis by ruling out other causes
      1. Metastases to bone
      2. Osteoporotic Fractures
  3. Findings: Early
    1. Soft tissue swelling
    2. Periosteal reaction (Subperiosteal elevation)
  4. Findings: Later
    1. Osteolysis with cortical loss and bony destruction
      1. Typical appearance is the "rat bite" (lytic lesions) of destroyed bony cortex
      2. Lytic changes not visualized until 50-75% of bone matrix is destroyed
    2. Sequestra (islands of necrotic bone)
    3. Bone abscess (Brodie's abscess)
  5. Efficacy
    1. Test Sensitivity: 62% (43-75% in Diabetic Foot Osteomyelitis)
    2. Test Specificity: 64% (65-83% in Diabetic Foot Osteomyelitis)
  6. Limitations
    1. Bone changes lag infection by 10-20 days
    2. XRay changes not seen until 40-70% bone resorbed
    3. Repeat XRay at 2 week intervals
  7. References
    1. Pineda (2006) Infect Dis Clin North Am 20:789-825 [PubMed]
    2. Termaat (2005) J Bone Joint Surg Am 87: 2464-71 [PubMed]

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