PMC6925771_01
Anteroposterior (a) and lateral (b) plain radiographs of the patient at the time of discharge from initial hospitalization reveal no abnormalities aside from the small cortical defect made by the IO cannula in the proximal tibia.
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Radiographs obtained revealed no fracture or abnormality aside from the cortical defects from the IO insertion (Figure 1).
Bilateral anteroposterior plain radiograph of the lower extremities one week after initial discharge demonstrating periosteal reaction of the tibia and striated lucencies of the distal femur.
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Plain radiographs revealed benign periosteal reaction at the IO site and subtle striated lucencies of the right distal femur attributed to disuse osteopenia by a pediatric musculoskeletal radiologist (Figure 2).
Anteroposterior (a) and lateral (b) plain radiographs of the patient two months after IO cannulation revealing progression of lytic processes in the distal femur and proximal tibia concerning for osteomyelitis.
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Two months later during routine follow-up with an ID specialist, radiographs obtained were concerning for osteomyelitis (Figure 3), so the child was sent back to the ED. Plain radiographs demonstrated progression of an osteolytic process involving the distal femur and proximal tibia with increased tibial periosteal reaction (Figure 3).
Sagittal (a) and axial (b) short tau inverted recovery (STIR) magnetic resonance imaging demonstrating extensive femoral and tibial edema consistent with osteomyelitis. In addition, two tibial abscesses distal to the physis and posteromedial muscle edema concerning for myositis were noted.
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MRI revealed distal femur and proximal tibia osteomyelitis with intraosseous abscesses and necrotic bone in the tibia (Figure 4).