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Emphysematous osteomyelitis is a rare but potentially fatal condition that must be considered whenever intraosseous gas is identified on imaging. The organisms implicated in most cases of emphysematous osteomyelitis are anaerobes or members of the Enterobacteriaceae family. Significant comorbidities, such as malignancy and diabetes mellitus, frequently predispose to this condition, and high mortality rates have been reported. The radiologist must be aware of the implications of identifying intraosseous gas in order to facilitate early diagnosis and expedite management. We report a unique case of a 58-year-old male with diabetes mellitus who presented with emphysematous osteomyelitis of the midfoot and necrotising fasciitis of the ipsilateral distal lower limb. Specimen cultures in this case revealed a pure growth of Group G Streptococcus.

Rounded atelectasis is an increasingly recognized but under-diagnosed and sometimes misdiagnosed pulmonary entity. This pictorial essay will present a broad range of examples of rounded atelectasis across different imaging modalities with inclusion of typical and atypical presentations. These examples will highlight imaging features that allow confident diagnosis and those that warrant further management, such as imaging surveillance, alternate imaging or invasive procedures for histological evaluation.

Systemic arterialization of the lung without pulmonary sequestration is the rarest form of anomalous systemic arterial supply to the lung. This condition is characterised by an aberrant arterial branch arising from the aorta which supplies an area of lung parenchyma with normal bronchopulmonary anatomy. It is often diagnosed following investigation of an incidental cardiac murmur or based on abnormal imaging, as most patients are asymptomatic or minimally symptomatic. Thoracic computed tomography and computed tomography angiography are generally the most useful diagnostic tests. We present a case of a 22-year old female who was diagnosed with systemic arterial supply to a portion of otherwise normal right lower lobe following investigation of low volume haemoptysis.

Diabetic complications in the lower extremity are associated with significant morbidity and mortality, and impact heavily upon the public health system. Early and accurate recognition of these abnormalities is crucial, enabling the early initiation of treatments and thus avoiding or minimizing deformity, dysfunction and amputation. Following careful clinical assessment, radiological imaging is central to the diagnostic and follow-up process. We aim to provide a comprehensive review of diabetic lower limb complications designed to assist radiologists and to contribute to better outcomes for these patients.

SummaryCharcot neuropathic osteoarthropathy (CN) is a progressive disease affecting the bones, joints and soft tissue of the foot and ankle, most commonly associated with diabetic neuropathy. Patients with diabetes complicated by CN have especially high morbidity, frequency of hospitalisation, and therefore, significant utilisation of expensive medical resources. The diagnosis of early CN can be challenging and is based on clinical presentation supported by various imaging modalities. Imaging is important for the detection of early CN and is useful in monitoring progression and complications of the disease. The later stages of CN are potentially devastating for individuals and present an increasing socioeconomic challenge for health systems. The astute radiologist, particularly in the context of a multidisciplinary team, plays a critical role in diagnosis of the primary disease and its complications. This review article aims to outline the key features of CN, emphasising current clinical and radiologic concepts as an aid for the practising radiologist.

The role of MR in the early diagnosis of acute osteomyelitis is well known. In the context of florid cellulitis, abnormalities of marrow signal are not uncommon, although they are often non-specific. Marrow oedema and enhancement in the context of deep cellulitis might reflect either reactive marrow oedema or true osteomyelitis. More specific signs lend favour to the diagnosis of osteomyelitis: these include focal bone destruction, periosteal reaction and sequestra. The observation of an extramedullary fat-fluid sign is also a specific sign for osteomyelitis, as illustrated in the following case report. This sign is an indication of cortical breach and, thus, in the setting of infection and in the absence of trauma confirms the presence of osteomyelitis. To our knowledge, this additional specific sign of osteomyelitis has not been previously reported on MR.

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