Limitation of plain radiography in bone infection

A young diabetic man presented with chills, rigors and proximal calf pain for 1 week duration. Local palpation revealed local tenderness in the knee area, particularly at the proximal tibia. Plain X-ray (above) shows small area of ill-defined lucent area in the metadiaphyseal region of the proximal tibia. There was no periosteal reaction noted. No obvious soft tissue abnormality.


MRI of the calf shows massive area of marrow oedema involving the proximal tibia as shown in the image above (coronal STIR sequence).

The imaging diagnosis is early osteomyelitis.

This case illustrates the sensitivity of MRI in detecting early bone infection. As with other diagnoses, early detection afford early intervention which limits the resultant damage.