Male, 5 months old. Radiographs with findings suspicious for osteomyelitis. BONE MARROW: Extensive bone marrow signal abnormality involving the left proximal femoral metaphysis and diaphysis, with increased signal on fluid sensitive sequences, low signal on T1, and diffuse bone marrow enhancement, compatible with osteomyelitis. There is significant periosteal reaction involving the proximal femur. The region of the femoral neck appears shortened, with local fluid and inflammatory changes, and no normal bone marrow signal or cortex, suggesting near complete bone destruction in this region. The left femoral head remains relatively normal in morphology and is positioned slightly posteriorly in the acetabulum. Wedge-shaped areas of low signal within the femoral head may reflect small regions of nonvascularized tissue.There is a moderate left hip joint effusion with extensive enhancement, suggesting infectious/inflammatory fluid within the joint.Inflammatory changes extend into the soft tissues surrounding the left hip, along the left gluteal musculature and into the overlying subcutaneous soft tissues. Bone marrow signal on the right is normal. The right femoral head is located within the acetabulum, and the surrounding soft tissues are normal. Mildly prominent inguinal lymph nodes, left slightly greater than right, are likely reactive.
1.Findings compatible with osteomyelitis involving the left proximal femur with associated destruction of the femoral neck, and additional inflammatory changes of the surrounding soft tissues.2.The left femoral head retains its morphology and is positioned within the acetabulum. Small regions of possible decreased vascularity involving the femoral head.3.Inflammatory/infectious left hip joint effusion.Findings were discussed via telephone with Dr. Bielski at 10:40 AM on 07/06/2016.