PMC6020494_01
Initial examination. (a) Plain radiograph of the knee showing no apparent abnormalities. (b) MRI demonstrating a high-signal intensity area at the epiphysis of the right proximal tibia in the short tau inversion recovery sequence.
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At the time of the initial examination, radiography of the knee showed no apparent abnormalities (Figure 1(a)). Magnetic resonance imaging (MRI) demonstrated a high-signal intensity area at the epiphysis of the right proximal tibia in the short tau inversion recovery sequence (Figure 1(b)).
After treatment with intravenous antibiotic chemotherapy. (a) Plain radiograph showing the epiphyseal radiolucent lesion extending to the metaphysis through the physis at the right proximal tibia. (b) MRI demonstrating an abnormality at the same site, extending across the high-signal intensity area of the physis in the three-dimensional fast field echo sequence.
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The epiphyseal radiolucent lesion had increased in size and extended to the metaphysis through the physis on a plain radiograph of the right proximal tibia (Figure 2(a)). MRI of the knee demonstrated an abnormality at the same site, extending across the high-signal intensity area of the physis in the three-dimensional fast field echo sequence at the right proximal tibia (Figure 2(b)).
Surgical drainage and curettage of the lesion were performed with an endoscope under C-arm fluoroscopy using double monitors. (a) Fluoroscopic monitor. (b) Endoscopic monitor.
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Surgical drainage and curettage of the lesion were performed with an endoscope under C-arm fluoroscopy (Figure 3).
Intraoperative histopathological examination (hematoxylin-eosin stain, x4). Arrow: caseous necrosis. Arrowhead: Langerhans giant cells.
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The lesion contained granulation tissue composed of caseous necrosis and Langerhans giant cells (Figure 4).
Endoscopic view from metaphysis to epiphysis through physis. (a) Endoscopic view under fluoroscopic guidance. (b) Lesion before drainage. (c) Lesion after drainage. Arrow: physis. *Epiphysis.
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After confirming adequate removal of the lesion, the surgery was finished (Figure 5).