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Challenging case of an intramedullary tibial abscess in the setting of chronic osteomyelitis
  1. Kevin Bain,
  2. Rebecca Grohman,
  3. Shinban Liu,
  4. Sareh Rajaee
  1. Department of Surgery, NYU Langone Hospital - Brooklyn, Brooklyn, New York, USA
  1. Correspondence to Dr Kevin Bain, kevin.bain{at}

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This is the case of a 43-year-old wheelchair-user man with a history of hepatitis C, cirrhosis, intravenous drug abuse and a 2-year history of chronic right lower extremity ulcers who presented to the emergency department with 4 days of worsening right leg pain. On physical exam, there was a new area of fluctuance on the anterior tibial surface. Labs included a white cell count of 9.3 K/µL, C reactive protein of 129 mg/L and erythrocyte sedimentation rate of 90 mm/hour. A CT scan demonstrated proximal tibia osteomyelitis with an intramedullary abscess, surrounding soft tissue abscesses and septic arthritis of the knee joint (figure 1).

Figure 1

(A) Permeative appearance of the proximal tibial metaphysis and diaphysis with areas of cortical lucency and endosteal scalloping, suspicious for osteomyelitis. (B) Intramedullary fluid collection within the proximal tibial metaphysis/epiphysis, containing hyperattenuating contents with two punctate foci of air measuring approximately 6.7×4.7×16.6 cm, suspicious for an intramedullary abscess. (C) Linear lucencies within the tibial cortex that communicate with multiple rim-enhancing …

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