Bone Pathology Database

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2nd image
Lateral X ray
Third image
Magnetic resonance of tibia
4th image
Magnetic resonance of femur.
The patient had a raised ESR and white cell count. The knee was drained but culture was negative. Xrays show a lytic lesion in the proximal tibial epiphyseal region and in the lateral part of the femoral metaphysis. The MR confirms the cystic nature of the lesion. The cysts were deroofed from an anterior approach. The lesion in the femur contained yellow pus and the femoral lesion contained grannulation like tissue.

As the lesions are on both sides of the knee a septic origin for the lesions is most likely. The high ESR and white count confirm sepsis as the cause. The lesion in the proximal tibia seems to cross the growth plate. This may occur with an intra osseous accumulation of pus such as a Brodie's abscess. The capsule of the knee crosses the epiphysis, this allows pus to get from an initial focus of osteomyelitis in one metaphysis into a joint causing septic arthritis. This knee sepsis allowed the sepsis to bridge from one metaphysis to the other.

Record 110