Desouza, Natalie Terese

Govindarajan, Prasanthi

eScholarship - University of California

UC IrvineWestern Journal of Emergency Medicine: Integrating Emergency Care with Population HealthTitleRadiographic Evidence of OsteomyelitisPermalinkhttps://escholarship.org/uc/item/4g5874dsJournalWestern Journal of Emergency Medicine: Integrating Emergency Care with Population Health, 12(4)ISSN1936-900XAuthorsDesouza, Natalie TereseGovindarajan, PrasanthiPublication Date2011DOI10.5811/westjem.2011.4.2256Copyright InformationCopyright 2011 by the author(s).This work is made available under the terms of a Creative Commons Attribution-NonCommercial License, available at https://creativecommons.org/licenses/by-nc/4.0/ Peer reviewedeScholarship.org Powered by the California Digital LibraryUniversity of CaliforniaIMAGES IN EMERGENCY MEDICINERadiographic Evidence of OsteomyelitisNatalie Terese Desouza, MDPrasanthi Govindarajan,MBBS, MASUniversity of California San Francisco, Department of Emergency Medicine,San Francisco, CaliforniaSupervising Section Editor: Sean Henderson, MDSubmission history: Submitted March 20, 2011; Revision received April 4, 2011; Accepted April 25, 2011Reprints available through open access at http://escholarship.org/uc/uciem_westjemDOI: 10.5811/westjem.2011.4.2256[West J Emerg Med. 2011;12(4):528–529.]A 40-year-old male with human immunodeficiency virus(currently, CD4 171) presented to our emergency department(ED) with pain and swelling in the left third digit of 3 to 4 weeks’duration. He noticed the swelling after a fist fight that resulted incompression of his ring on the finger. He did not report anyhistory of fever, bleeding, or discharge. Upon arrival to the ED,the ring was removed with a cutter. On examination, he had adigit that was sausage shaped in neutral position with no blood orpurulence (see Figure 1). Movement was significantly limited bypain, sensation was decreased, and capillary refill was delayed.Radiographic imaging with plain film was performed and acomplete blood count was obtained (see Figure 2).The radiograph (Figure 2) confirmed periosteal reaction inthe cortex of the proximal third phalanx, concerning forosteomyelitis. The diagnosis of osteomyelitis was confirmed bymagnetic resonance imaging during hospital admission. Thepatient began a 6-week course of Ertapenem to cover for thepolymicrobial nature of the infection. Osteomyelitis is aninfection of the bone. Early and accurate diagnosis is important,since it requires long-term antibiotic therapy and should beconsidered for patients with signs of infection with bone pain.In osteomyelitis, inflammatory exudate in the marrow leads toincreased intramedullary pressure, with extension of exudateFigure 1. Photograph of the patient’s hand on the day he presentedto the emergency department after his ring was removed.Figure 2. Radiograph of the patient’s hand demonstratingperiosteal elevation consistent with osteomyelitis.Western Journal of Emergency Medicine Volume XII, NO. 4 : November 2011528into the cortex. This splits the periosteum, leading to loss ofblood supply and resulting in necrosis.1 The resulting deadbone (sequestrum) is visualized on radiographs.1 New boneformation (involucrum) around damaged periosteum can alsobe seen radiographically, but might not be seen early in thecourse of the disease.1Address for Correspondence: Natalie Desouza, MD, University ofCalifornia San Francisco, Department of Emergency Medicine, 55Laguna St, San Francisco, CA 94102-6232. E-mail: natalie.desouza@ucsf.edu.Conflicts of Interest: By the WestJEM article submissionagreement, all authors are required to disclose all affiliations,funding sources, and financial or management relationships thatcould be perceived as potential sources of bias. The authorsdisclosed none.REFERENCES1. Pineda C, Espinosa R, Pena A. Radiographic imaging in osteomyelitis:the role of plain radiography, computed tomography, ultrasonography,magnetic resonance imaging, and scintigraphy. Semin Plast Surg. 2009;23:80–89.Volume XII, NO. 4 : November 2011 Western Journal of Emergency Medicine529Desouza and Govindarajan Radiographic Evidence of Osteomyelitis

Radiographic Evidence of Osteomyelitis

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