![]() ![]() Electronic Cigarette Use Among Patients with Cancer: Characteristics of Electronic Cigarette Users and Their Smoking Cessation Outcomes. Erratum: Borderud SP, Li Y, Burkhalter JE, Sheffer CE and Ostroff JS. Ralph Weissleder, Jack Wittenberg, Mukesh G. ![]() MRI Findings of Septic Arthritis and Associated Osteomyelitis in Adults. Karchevsky M, Schweitzer M, Morrison W, Parellada J. Musculoskeletal Infection: Role of CT in the Emergency Department. Osteomyelitis should be suspected if bone marrow edema extends in the medullary space in the setting of suspected or proven septic arthritis 10 Therefore, timely diagnosis and treatment are critical. Osteonecrosis is also an important sequela of septic arthritis due to effusion and an increase in intra-articular pressure which compromises blood circulation.Ĭonversely, approximately 90% of patients with septic arthritis will recover with appropriate antibiotic treatment. If unrecognised and left untreated, septic arthritis can result in irreversible joint damage within 48 hours of the onset of infection due to the proteolytic enzymes of the white blood cells that flood the infected synovial space. For larger joints or persistent infection, surgical debridement and washout will be required 4. With smaller joints needle drainage or aspiration to decompress the joint followed by antibiotics may be adequate. This will allow focussed treatment of the infection 4. If the patient is hemodynamically stable then attempts should be made to obtain a sample of joint fluid for microscopy and culture prior to starting treatment with antibiotics. The treatment principle for septic arthritis is prompt drainage of purulent fluid and appropriate antibiotics 7. T1 C+ (Gd): synovial enhancement reflecting synovitis pericapsular enhancement 10 T2: thin rim of subchondral edema pericapsular edema 10 T1: low signal within the subchondral bone MRI is sensitive and more specific for early cartilaginous damage with joint effusion being characterization 10. ![]() Useful in superficial joints and in childrenĬolor Doppler may show increased peri-synovial vascularityĬT features of septic arthritis are similar to those spotted on radiographsĪ fat-fluid level can be a specific sign in the absence of trauma If left untreated, reactive juxta-articular sclerosis and, in severe cases, ankylosis will develop Narrowing of the joint space due to cartilage destruction in the acute phaseĭestruction of the subchondral bone on both sides of a joint Juxta-articular osteoporosis due to hyperemia May be normal in the very early stage of the disease If synovial fluid cannot be retrieved, however, radiologic studies become of the utmost importance. Imaging generally plays an adjunct role to arthrocentesis in the diagnosis of joint sepsis. The Hunka classification is used to grade the anatomical deformity following septic arthritis in a pediatric hip. In intravenous drug users, the sternoclavicular and sacroiliac joints are more frequently affected. Large joints with abundant blood supply to the metaphyses are most prone to bacterial infection, with the most commonly affected joints theoretically being the shoulder, hip, and knee. Gonococcal as a cause is not uncommon in young adults and adolescents 9. Haemophilus influenzae was once a common causative agent for septic arthritis in children under the age of 2 but has significantly reduced in incidence due to vaccination 8,9. Staphylococcus aureus is the most commonly isolated agent 6 as well as Streptococci spp., Pseudomonas, Escherichia coli, and Serratus 10. In the absence of trauma or recent instrumentation of the joint, septic arthritis is usually secondary to hematogenous seeding. The diagnosis of joint sepsis is often considered straightforward. Patients often present with a painful joint, fever and purulent synovial fluid. Risk factors for septic arthritis include: ![]()
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