PMC6971166_01
Comparison of sequential radiographs obtained on day 0 and day 18, and bone window computed tomography scan on day 22 (A-C, respectively), highlighting the failure of radiographs to elucidate the severity of bone involvement. (A) Lateral-medial radiograph taken on day 0. (B) Lateral-medial radiograph taken on day 18, revealing osseous proliferation along the dorsal margin of the proximal row of carpal bones (arrow head). (C) Sagittal CT image from day 22, revealing lysis of the radiocarpal bone (arrow) with reactive periostitis (arrowhead).
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F1
Serial synovial fluid analyses, thoracic radiographs and carpal radiographs were performed throughout hospitalization, with no obvious radiographic changes noted until day 18 (Figure 1). On day 18, carpal radiographs were repeated, and mild-to-moderate periostitis was noted on the intermediate and third carpal bones, in addition to a questionable focal area of lysis in the radiocarpal bone (Figure 1B). Most significantly affected was the radiocarpal bone, with a 2.4 x 0.7 cm lesion medially, spanning the proximodistal height of the radiocarpal bone (Figure 1C).
PMC6971166_02
Sequential lateral-medial tarsal radiographs following the progression of the distal tibial physeal lesion (white arrows). (A) Referral radiographs, 10 days prior to presentation, (B) day 5, (C) day 15, and (D) day 19 after presentation, revealing severe osteomyelitis and Penrose drain (black arrowhead).
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F2
Radiographs of the left tarsus revealed a focal, 3.5 cm diameter area of expansion characterized by heterogenous lysis dorsolaterally on the distal tibial physis with moderate periosteal reaction (Figure 2A). The physeal lucency continued to expand in size radiographically (Figure 2). On day 19, the lameness became acutely more severe, and radiographs revealed extension of physeal infection and osteomyelitis (Figure 2D).
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