‘Twas the night before Christmas

This holiday season, I am grateful for the support you have given me. Sharing my love and passion for radiology with you every day is a great gift and has been the highlight of 2017. Thank you for reading every day.

In return, my Christmas gift to you is a short case. Happy Holidays everyone!

‘Twas the night before Christmas, when all through the hall, not an intern was stirring, exhausted from call. The front desk was eating the candy and tootsies, but right down the corridor lay some very sick footsies.

Q – What is wrong with the footsies?

A – Hyperintense edema on the water weighted image on the left detects ill-defined marrow swelling only with minimal distal focality. It is the “bone scan-like” sensitive sequence, lacking in specificity, but strong in detection or sensitivity.

However, when it comes to osteomyelitis, T1 is the key. If the T1 is normal, there is NO invasive osteomyelitis. In this example, the tuft of digit one has a “bite” taken out of it on T1 or the fat weighted image (red circle) along the toe’s medial cortical edge.

This is the “bone erasure sign” we have described for invasive osteomyelitis.

“So Santa descended with a PIC line and drugs, wearing his cherry red holiday scrubs. He looked in his bag for biotics that worked, but soon realized by the elves that he’d been jerked. For the patient had suffered from MRSA, and the drug is now available… well, that’s a story for another day.”