PMC6317299_01
Plain radiograph showing lucent lesion of the central mid-to-distal right femoral medullary space.
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ALT 124 u/L), and mildly elevated C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) of 13.40 mg/L and 58 mm/hour, respectively. An X-ray of the right lower extremity demonstrated a lucent lesion of the central mid to distal medullary space of the femur (Fig. 1), suspicious for an infarct or chronic osteomyelitis.
MRI (Short-TI Inversion Recovery, STIR) without contrast showing a 24-cm cystic lesion of the right femur with surrounding bony sclerosis and periosteal edema consistent with atypical infection.
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MRI revealed a 24 cm cystic lesion centered in the diaphysis spanning down to the distal metaphysis, with internal complex fluid levels and thickened cortex surrounding the collection (Fig. 2), concerning for chronic osteomyelitis with abscess formation.