Subacute and Chronic Osteomyelitis

If not treated promptly and effectively by an antibiotic regimen and/or operative fenestration, the acute infection is transformed into the subacute or chronic forms. Pathologically, abscess, necrosis, bony proliferation, cortical and periosteal thickening, and deformity are seen. It is during this stage of disease that the sequestra and involucra develop. Abscesses may be produced by the coalescence of suppurative foci in subacute and chronic osteomyelitis. They are walled-off by a prominent bone reaction and usually accompanied by the thickening of the cortex and periosteum.

Radiographically, the chronic osteomyelitis manifests bizarre bone changes that include protean trabecular and cortical thickening, ra-diolucent defect, periosteal reaction, and deformity (Fig. 6.10A). The intramedullary localization, a hallmark of osteomyelitis, is well maintained regardless of the chronicity of the

Acute Osteomyelitis

Fig. 6.6A-C Three-phase 99mTc-MDP bone scintigraphy in acute osteomyelitis. A Blood flow scan of both legs in a 5-year-old girl with pain and fever in the left knee shows increased vascularity in the left proximal tibial metaphy-sis (arrowheads). B Planar bone scintigraph shows in

Acute Osteomyelitis

Fig. 6.6A-C Three-phase 99mTc-MDP bone scintigraphy in acute osteomyelitis. A Blood flow scan of both legs in a 5-year-old girl with pain and fever in the left knee shows increased vascularity in the left proximal tibial metaphy-sis (arrowheads). B Planar bone scintigraph shows in creased uptake in the left proximal tibial metaphysis that is inseparable from the epiphyseal uptake (arrow). C Pinhole scintigraph clearly localizes pathological uptake to the metaphysis (arrow)

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