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.
Facial nerve schwannoma is a rare primary neurogenic tumour that may originate anywhere along the VII(th) nerve course. The clinical presentation is highly dependent on the location of the lesion along the nerve course and this makes the pre-operative diagnosis difficult without radiologic examination. The most common presentation is facial palsy and even though tumours are responsible for only 5% of facial palsies, if a patient does not recover within six months a complete work-up for neoplasm is recommended. On the basis of clinical presentation and imaging characteristics radiologists should try to make a preoperative diagnosis, to help in the patient's management and possibly to plan the surgical approach. We describe the case of a successful preoperative diagnosis of facial nerve schwannoma. The aim is to describe the main CT and MRI findings which may help the radiologist to establish a correct differential diagnosis.
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