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DDx 🏳️🌈
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- Spine: inflammatory vertebral end plate degeneration
- Hip: rapidly-destructive hip OA
- Legs: tibia, fibula, & metatarsal (stress) fractures
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- Primary: osteoid osteoma
- Metastatic: any cancer
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- Neurogenic Osteoarthropathies: complex regional pain syndrome & acute Charcot
- Vascular: Raynaud’s, avascular necrosis (e.g. sickle cell)
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- Osteomalacia
- Hyperparathyroidism
- Scurvy
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- Ankylosing spondylitis
- Amyloidosis
- SAPHO syndrome
- Chronic recurrent multifocal osteomyelitis (CRMO)
- RT-induced osteonecrosis & foreign body reaction
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- (Pseudo)gout
- Calciphylaxis
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Principles❗️
- Osteomyelitis 🦴 : bone inflammation due to infection, which is usually but not always supported by elevated serum inflammatory markers & therefore often requires bone biopsy to culture a culprit organism.
- Osteomyelitis mimickers 🦴 : a product of the heterogeneous radiographic presentations of osteomyelitis that are not necessarily specific for OM.
- Osteomyelitis MRI findings 🩻 : typically a T1 hypointensity is seen due to pyogenic replacement of normal fatty marrow tissue. This leads to loss of the normal distinction between the bone cortex & medulla. On T2, affected areas are hyperintense. This is usually reported as “marrow edema,” & affected areas typically enhance with contrast.
