Spontaneous emphysematous osteomyelitis of spine detected by computed tomography: Report of two cases

Aiyappan, Senthil Kumar; Ranga, Upasana; Veeraiyan, Saveetha

doi:10.4103/0974-8237.139207

Cited by 19 publications

(10 citation statements)

References 7 publications

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“…Hematogenous dissemination is the most common route of spread of infection. [ 5 6 ] However, McDonnell et al . have also reported rare modes of disease spread, such as an extension of intraabdominal infection, intraabdominal, or spinal surgery, or from skin or soft tissue infection.…”

Section: Discussionmentioning

confidence: 99%

“…Presence of intraosseous gas in intravertebral space is generally a feature of disc degeneration; however, extensive intraosseous gas, bone marrow edema, and/or adjacent fluid collections should raise the possibility of emphysematous osteomyelitis, which was the possible scenario in our second case that showed evidence of intraosseous gas with adjacent fluid collection in the pelvis. [ 5 ]…”

Section: Discussionmentioning

confidence: 99%

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Emphysematous osteomyelitis: Report of two cases and review of literature

Khanduri

Singh

Goyal

et al. 2018

Indian Journal of Radiology and Imaging

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Emphysematous osteomyelitis is a rare condition characterized by the presence of intraosseous gas. A prompt diagnosis is required for this disease to expedite management as it is a potentially fatal condition. Many comorbidities, such as malignancy, diabetes mellitus, alcohol abuse, Crohn's disease, and other etiologies causing immunosuppression, predispose to this condition. The causative organisms are generally anaerobes or members of Enterobacteriaceae family; however, the infection can be mono or polymicrobial. We report two cases affected with emphysematous osteomyelitis due to varied underlying comorbidities. The purpose of this study is to (a) emphasize the importance of computed tomography in diagnosing emphysematous osteomyelitis and (b) to highlight an unusual location of this rare pathology.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Emphysematous osteomyelitis: Report of two cases and review of literature

Khanduri

Singh

Goyal

et al. 2018

Indian Journal of Radiology and Imaging

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“…Emphysematous osteomyelitis should be considered as one of the possible diagnoses if intraosseous gas is detected, especially in the extra-axial skeleton ( 22 ). The differential diagnosis of intraosseous gas includes trauma, post-surgical change, lymphangiomatosis of the bone, degenerative disease, osteonecrosis, and neoplasm ( 19 , 24 ).…”

Section: Discussionmentioning

confidence: 99%

Emphysematous Osteomyelitis of the Spine: A Case Report and Literature Review

2018

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Emphysematous osteomyelitis is a rare but potentially fatal infection. It is caused by gas-forming organisms and is characterized by the presence of intraosseous gas. A 75-year-old woman with untreated diabetes mellitus presented with difficulty in moving and anorexia. Laboratory studies revealed inflammation, a urinary infection, and diabetic ketoacidosis. Klebsiella pneumoniae was detected in both urine and blood cultures. Computed tomography and magnetic resonance imaging revealed emphysematous lesions in the paravertebral soft tissue, spinal canal, and iliopsoas muscle, with intraosseous gas at L1 and L2. These findings led to a diagnosis of emphysematous osteomyelitis. We herein review 35 reported cases of emphysematous osteomyelitis including our case.

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“…A total of 440 CT examinations, taken within a two-week period before or after initial and follow-up MRIs, were reviewed to look for intraosseous and/or paraspinal gas. Gas-forming osteomyelitis can be established by the detection of intraosseous gas (8–12). However, intravertebral gas can be present due to degenerative disease, osteonecrosis, or a neoplastic process, so we cautiously evaluated intraosseous gas.…”

Section: Methodsmentioning

confidence: 99%

Atypical infectious spondylitis with reduced bone marrow enhancement: “black vertebra sign”

et al. 2020

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Background A few patients suspected of having infectious spondylitis exhibited a reduced enhancement pattern on postcontrast T1-weighted (T1W) magnetic resonance imaging (MRI). Purpose To investigate the characteristics of infectious spondylitis patients who exhibited reduced vertebral enhancement. Material and Methods From January 2010 to November 2017, 456 patients with findings suspicious for infectious spondylitis on 706 postcontrast T1W imaging were retrospectively evaluated. When an affected vertebra exhibited markedly reduced enhancement compared to normal bone marrow (BM), the vertebra was termed a “black vertebra.” MRI and computed tomography (CT) imaging findings within two-week intervals and the patients’ clinical characteristics were reviewed. Results Ten patients (5 men, 5 women; mean age 66.4 years) whose MRI scans revealed the black vertebra sign were included. Among the 10 patients with black vertebrae, six patients exhibited signal voids in or around the affected vertebral bodies on T2-weighted (T2W) images. Eight patients showed air bubbles on CT images, suggestive of emphysematous infection. However, the typical image findings of infectious spondylitis were uncommon, namely, low BM signal intensity (SI) on T1W images (n=1) and intradiscal fluid-equivalent SI on T2W images (n=5) at an early stage. On follow-up MRI (average interval 7.2 weeks from initial MRI), available for five patients, marked progression of infection was evidenced by increased numbers of affected segments (n=3), low T1 SIs of the affected vertebrae (n=5), and increased contrast enhancement (n=3). Five patients underwent surgery to treat infections not controlled by antibiotics. Conclusion A black vertebra sign on postcontrast T1W imaging seems to reflect an early emphysematous infection.

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Spontaneous emphysematous osteomyelitis of spine detected by computed tomography: Report of two cases

Cited by 19 publications

References 7 publications

Emphysematous osteomyelitis: Report of two cases and review of literature

Emphysematous osteomyelitis: Report of two cases and review of literature

Emphysematous Osteomyelitis of the Spine: A Case Report and Literature Review

Atypical infectious spondylitis with reduced bone marrow enhancement: “black vertebra sign”

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