CT detection of intraosseous gas: a new sign of osteomyelitis

Ram, Panol C.; Martínez, S; Korobkin, Melvyn; Breiman, Richard S.; Gallis, H R; Harrelson, John M.

doi:10.2214/ajr.137.4.721

Cited by 122 publications

(58 citation statements)

References 6 publications

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“…In 1981, for the first time, Ram and colleagues described three patients with emphysematous osteomyelitis involving the tibia, pelvis, and fibula, respectively [2]. Until now, only 29 cases have been reported in the English literature globally [1678].…”

Section: Discussionmentioning

confidence: 99%

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Emphysematous Osteomyelitis due to Escherichia coli

et al. 2017

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Emphysematous osteomyelitis, especially that involving the extra-axial skeleton, is an extremely rare presentation but associated with significant morbidity and mortality. Here, we report a case in which a 58-year-old female patient with diabetes mellitus presented with emphysematous osteomyelitis that involved the sternum, clavicle, and pelvic bone and was caused by Escherichia coli via hematogenous spread of urinary tract infection. We successfully treated her with urgent and aggressive surgical drainage with prolonged antibiotics therapy. Early diagnosis and immediate surgical intervention are required for better outcomes in cases of emphysematous osteomyelitis.

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Section: Discussionmentioning

confidence: 99%

“…The first case of emphysematous osteomyelitis was reported in 1981 [2], and only 29 cases have been reported globally thus far. To the best of our knowledge, no case of emphysematous osteomyelitis has been reported from Korea.…”

Section: Introductionmentioning

confidence: 99%

Emphysematous Osteomyelitis due to Escherichia coli

et al. 2017

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“…Afterward, we did a wound cleaning with 12 liters of saline irrigation using a pressure gun (Cleanest TM) wich suctions the liquid at the same time. In the immediate postoperative period, we initiated empirical treatment with intravenous linezolid 600 mg/12 h and voriconazole 400 mg/12 h. Subsequently, we withdrew voriconazole due to the growth of an E. faecalis in both cultures, preoperative and intraopera- The presence of gas into the joints or soft tissues was first described in 1981 by Ram CR, et al [4] stating that, in the absence of trauma that would justify the entry of gas into the bone tissue, the intramedullary gas is the result of microorganisms infiltrating the bone secondary to infections surrounding soft tissues, thus infecting the medullary cavity. Osteomyelitis with an extramedullary gas formation is usually generated by anaerobic microorganisms [1], and it is not uncommon to visualize them in complementary tests which help us with the diagnosis.…”

Section: Casementioning

confidence: 99%

Intramedullary Gas not Related to Infection

Barquiel¹

2017

J Musculoskelet Disord Treat

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The presence of gas in joints or soft tissues is usually indicative of infectious pathology or degenerative diseases [1]. However, the presence of gas inside the medullary canal in the diaphysis of long bones is an uncommon condition, and it is often associated with fractures or previous surgeries.We present the case of a 29-year-old man who suffered an open supraintercondylar femur fracture, treated with debridement, surgical scrub with saline solution, and stabilization by external fixator, and in a second stage with a definitive osteosynthesis, which after being washed with pressure gun presented abundant intramedullary gas non-related to infectious pathology but possibly related to a pulsatile jet lavage during surgery. CASE REPORTture; 2: articular simple, metaphyseal multifragmentary) supraintercondylar fracture of the right femur with Gustilo-Anderson type IIIA ( Figure 1A), and an AO34-C1 (3: femur; 4: patella; C: complete articular; 1: transverse) non-displaced fracture of the right patella. Extensive wound cleaning was immediately performed at the emergency department, with manual irrigation using saline solution, as well as debridement of the most superficial contaminant material and temporary approximation of the wound edges. According to our hospital open fracture protocol, intravenous antibiotherapy was initiated with cefuroxime 1 g every 8 hours for 3 days and gentamicine 240 mg every 24 h for 3 days.He was taken to the operation room where we conducted first an antegrade intramedullary nailing of the left femur with a Synthes Expert femoral nail, using a traction table. Secondly, on the right femur, we performed a resection of the wound edges according to Friederich, a debridement of the contaminating deep tissue and the fracture focus, manual wound cleaning with saline irrigation, and temporary fixation of the supracondylar fracture with an external fixator (Hoffman II, Synthes). Given the fact that the patella fracture was non-displaced, there were no more surgical procedures.Subsequently, a CT scan of the right knee was performed in order to complete the preoperative studies so we could make a good surgical planning ( Figure 1B), which did not show any intraosseous air bubbles. After CaseThe patient is a 29-year-old man with no history of interest, who was taken to our hospital on November 2015 approximately one hour after suffering a high energy traffic accident. He was a motorbike rider hit by a car riding at high speed. He was received at the emergency department where advanced life support measures were applied. After the stabilization of the patient, the body-CT showed contusive focus in both pulmonary bases, discarding other internal emerging lesions.In the radiological series, we identified an AO32-B2 (3: femur; 2: diaphyseal; B: with a wedge fragment; 2: bending wedge) fracture of the left femur, an open AO33-C2 (3: femur; 3: distal; C: complete articular frac-

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“…1 Intraosseous gas within the femur on plain films was also described by Patton et al in 1983. 2 The presence of intraosseous gas in the absence of recent surgery or compound fracture is highly indicative of emphysematous osteomyelitis.…”

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confidence: 91%

Emphysematous osteomyelitis of the forefoot

Abdelbaki

Bhatt

Gupta

et al. 2017

Baylor University Medical Center Proceedings

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Emphysematous osteomyelitis is a very rare, potentially fatal infection that requires immediate diagnosis and prompt treatment. Emphysematous osteomyelitis is usually considered whenever intraosseous gas is detected on imaging. Most organisms implicated in emphysematous osteomyelitis are members of the Enterobacteriaceae family or anaerobes; sometimes the infection is polymicrobial. We report a case of emphysematous osteomyelitis of the forefoot in a 33-year-old man with type 1 diabetes mellitus.

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CT detection of intraosseous gas: a new sign of osteomyelitis

Cited by 122 publications

References 6 publications

Emphysematous Osteomyelitis due to Escherichia coli

Emphysematous Osteomyelitis due to Escherichia coli

Intramedullary Gas not Related to Infection

Emphysematous osteomyelitis of the forefoot

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