A CASE PRESENTATION
Dr Dipendra Maharjan
First year Resident,
Department of Orthopaedics
NAMS
Share your knowledge.It’s a way to achieve
immortality. Dalai Lama It is the province of
knowledge to speak, and it is the...
9 yrs/Female
Melung dolkha
Presented to opd on 26/5/2014
Chief Complain
Pain over the left leg for 7 days
• pain over left leg
– increases in night
– relieves by analgesics for short period.
• No h/o
– Trauma
– Fever
– constitut...
• On examination
– GC was fair, normal nutritional status
– Vitals - stable
• Systemic examination were normal and
unremar...
Initially, we did blood examination,
plain x-ray and USG of left leg
• Blood investigation showed:
– Wbc-9.1 N 55 L 48
– H...
Plain X-ray of Left leg
Ultrasound of Left Leg
All findings were not suggestive of
any specific disease,
so
we ordered MRI of left leg
MRI of left leg
Diagnosis
Acute osteomyelitis of Left tibial
shaft
Treatment
• Emergency corticotomy and drainage
• Perioperative findings-
– no pus only blood
• Postoperatively-
– marked i...
BUT….
• Suddenly
– Developed pain over the right leg with similar
intensity and character
– Mostly at night and crying all the t...
Pain X-ray of right leg
MRI of right leg
MRI report suggestive of acute
osteomyelitis of right leg
Treatment same as before
• Emergency Corticotomy and drainage
• Intra-op findings were similar
• Post operatively, symptom...
DIAGNOSIS
NON-SUPPURATIVE MULTIFOCAL
OSTEOMYELITIS
• Multifocal often multifocal recurrent lesions.
• Long bone metaphyses, clavicles, anterior
ribcage
• SAPHO- synovitis, a...
• Findings-
– Tempreture increase
– ESR increase
• X-RAY-
– Lytic lesion with sclerosis around
• Radioscintigraphy-
– incr...
FINALLY AWAITED REPORT
ARRIVED….
BIOPSY REPORT
What will be the diagnosis?
Thank You!!
Nabita shrestha
of 25

Nabita shrestha

A case study regarding bilateral tibial osteomyelitis
Published on: Mar 3, 2016
Published in: Health & Medicine      
Source: www.slideshare.net


Transcripts - Nabita shrestha

  • 1. A CASE PRESENTATION Dr Dipendra Maharjan First year Resident, Department of Orthopaedics NAMS
  • 2. Share your knowledge.It’s a way to achieve immortality. Dalai Lama It is the province of knowledge to speak, and it is the privilege of wisdom to listen. Oliver Wendell Holmes, Sr. If you have knowledge,let others light their candles in it.Margaret Fuller
  • 3. 9 yrs/Female Melung dolkha Presented to opd on 26/5/2014 Chief Complain Pain over the left leg for 7 days
  • 4. • pain over left leg – increases in night – relieves by analgesics for short period. • No h/o – Trauma – Fever – constitutional symptoms. • No other significant history as well as signs and symptoms.
  • 5. • On examination – GC was fair, normal nutritional status – Vitals - stable • Systemic examination were normal and unremarkable • Local examination of left leg: – Overlying skin was intact – no swelling – no redness – Temperature was not increased – Mild tender mid shaft area
  • 6. Initially, we did blood examination, plain x-ray and USG of left leg • Blood investigation showed: – Wbc-9.1 N 55 L 48 – Hct 37 – ESR- 25 – CRP- 21
  • 7. Plain X-ray of Left leg
  • 8. Ultrasound of Left Leg
  • 9. All findings were not suggestive of any specific disease, so we ordered MRI of left leg
  • 10. MRI of left leg
  • 11. Diagnosis Acute osteomyelitis of Left tibial shaft
  • 12. Treatment • Emergency corticotomy and drainage • Perioperative findings- – no pus only blood • Postoperatively- – marked improvement of symptoms.
  • 13. BUT….
  • 14. • Suddenly – Developed pain over the right leg with similar intensity and character – Mostly at night and crying all the time due to pain • Examination findings were similar – No swelling, tender over mid shaft region
  • 15. Pain X-ray of right leg
  • 16. MRI of right leg
  • 17. MRI report suggestive of acute osteomyelitis of right leg
  • 18. Treatment same as before • Emergency Corticotomy and drainage • Intra-op findings were similar • Post operatively, symptoms relieved.
  • 19. DIAGNOSIS NON-SUPPURATIVE MULTIFOCAL OSTEOMYELITIS
  • 20. • Multifocal often multifocal recurrent lesions. • Long bone metaphyses, clavicles, anterior ribcage • SAPHO- synovitis, acne, pustulosis hyperostosis, osteitis • Subacute inflammatory condition- bone thickening and round cell infiltration.
  • 21. • Findings- – Tempreture increase – ESR increase • X-RAY- – Lytic lesion with sclerosis around • Radioscintigraphy- – increased activity • Biopsy- – typical features of acute or subacute inflammation. • Treatment- – Palliative ANTIBIOTIC HAS USUALLY NO ROLE
  • 22. FINALLY AWAITED REPORT ARRIVED…. BIOPSY REPORT
  • 23. What will be the diagnosis?
  • 24. Thank You!!

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