Multifocal emphysematous osteomyelitis, a do not miss diagnosis for the emergency radiologist: a case report with literature review

Emerg Radiol. 2024 Apr;31(2):285-288. doi: 10.1007/s10140-024-02203-7. Epub 2024 Jan 25.

Abstract

Emphysematous osteomyelitis (EO) is an uncommon fatal condition with high morbidity and mortality. Simultaneous involvement of the axial and appendicular skeleton with multifocal disease is even rarer, with only a few cases being reported in the literature. We present a case of multifocal emphysematous osteomyelitis in a 56-year-old woman with concurrent emphysematous pyelonephritis complicated by psoas and epidural abscesses. The causative organism in our patient was Escherichia coli. Emergency radiologists should be aware of this condition and differentiate it from other benign entities that can present with intraosseous gas. Prompt diagnosis is important given the high morbidity and mortality with this condition. This case report emphasizes the specific pattern of intraosseous gas seen with EO, which can help diagnose EO with confidence.

Keywords: Escherichia coli; Emphysematous osteomyelitis; Emphysematous pyelonephritis; Epidural abscess; Intraosseous air; Intraosseous gas; Multifocal; Psoas abscess; Review.

Publication types

  • Review
  • Case Reports

MeSH terms

  • Emphysema* / diagnostic imaging
  • Female
  • Humans
  • Middle Aged
  • Osteomyelitis* / diagnostic imaging
  • Pyelonephritis* / diagnostic imaging
  • Tomography, X-Ray Computed / adverse effects