Sclerosing Osteomyelitis of Garre

This is a rare nonpurulent variant of subacute or chronic osteomyelitis. Pathologically, the condition is characterized by prominent proliferation and thickening of the periosteum and spongy trabeculae, but with little pus formation, necrosis, or granulation tissue. The mandible is the typical site of involvement. When a long bone is affected the diaphysis is the site of predilection, and this finding contrasts with the metaphyseal predilection of acute osteomyelitis.

Radiography shows diffuse thickening of the cortex, endosteum, and cancellous bones with resultant medullary space obliteration. It typically involves the mandible or the midshaft of a long bone (Fig. 6.20A).

Ordinary bone scintigraphy reveals intense void uptake in the middle portion of a long bone. The uptake is homogeneous without a particular feature (Fig. 6.20B). Pinhole scan, however, shows the homogeneous uptake to consist of two clearly separate zones: the more

Fig. 6.20A-C Intramedullary localization of tracer in sclerosing osteomyelitis of Garre. A Anteroposterior radiograph of the right femoral shaft in a 36-year-old man with a chronic bone infection shows marked bony sclerosis with minimal expansion (arrows). B Ordinary anterior spot scintigraph reveals intense tracer uptake without specific textural features (arrow). C Anterior pinhole scintigraph specifically localizes extremely intense tracer uptake of osteomyelitis in the marrow space (arrow) with much less intense uptake in the associated bone reaction in the cortex (arrowheads)

Osteomyelitis Garr

Fig. 6.21A, B Old osteomyelitis. A Anteroposterior radiograph of the right femur in a 31-year-old man with an ill-defined "pain" in an old osteomyelitis site reveals a thickened cortex with medial angulation (curved arrow). B Anterior pinhole scintigraph shows moderate tracer uptake in the concave lateral border of the affected area (curved arrow) but no abnormal tracer uptake in the thickened, convex medial border. The increased uptake in the lateral border may be related to increased bone turnover due to more stressful weight bearing (Wolff's law)

Fig. 6.21A, B Old osteomyelitis. A Anteroposterior radiograph of the right femur in a 31-year-old man with an ill-defined "pain" in an old osteomyelitis site reveals a thickened cortex with medial angulation (curved arrow). B Anterior pinhole scintigraph shows moderate tracer uptake in the concave lateral border of the affected area (curved arrow) but no abnormal tracer uptake in the thickened, convex medial border. The increased uptake in the lateral border may be related to increased bone turnover due to more stressful weight bearing (Wolff's law)

intense uptake in the medullary space and the less intense uptake in the thickened corticope-riosteal layer (Fig. 6.20C). The former represents the main chronic infective focus in the bone marrow and the latter the associated cor-ticoperiosteal reaction. The medullary uptake is uniform and expansive. Tracer uptake in a longstanding, inactive osteomyelitis is reminiscent at most, but the radiographic sclerosis is prominent and persistent (Fig. 6.21). It is to be noted that, if present, the concave border of the angulated long-bone shaft may accumulate tracer intensely, reflecting undue stress carried by this deformed part (Wolff's law).

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