The xray shows changes noted in chronic osteomyelitis. Chronic osteomylitis is a condition that occurs as a sequel to acute osteomyelitis. Osteomylitis means infection of the bone and bone marrow inmedullary cavity.
In the present film, on left side is a lateral view of lower end of femur with knee joint. On right side is anteroposterior view.
The features that are seen in this xray pointing to probable diagnosis of osteomyelitis are
- Cortical thickening – There appears widening in the part of femur that is 5 cm above knee joint.
- Irregularity of cortices- There is a difference in outline of femoral bone. In the lower part it is very straight and smooth. After that it becomes zigzag.
- Sclerosis- The affected part is more white than the rest of femur if you look carefully.
What else it could be?
In medical terminology this is called differentials. If you just see the xray without seeing the patient, the first thing that comes into mind would be osteomyleitis.
The picture can be confused to some extent with hypertrophic callus in fracture but chances are less likely.
Chronic osteomyelitis classically shows presence of sequestrum or dead bone which is not present in the present film. This was a patient who was just 25 years old and suffered acute osteomyelitis 8 years back. He had come for treatment of stiffness of knee which was present since he had this acute episode.
He did not have any discharging sinus and was not symptomatic for the involved region in the xray.