The life-saving little tip: intraosseous gas

SUMMARY A case is presented of an-aerobic osteomyelitis with intraosseous gas resulting in the extension of gas in soft tissue structures in a patient with diabetes mellitus. The finding of intraosseous gas and its extension into the pubic joint and the left anterior abdominal wall is depicted. Intraosseous gas is a rare but worrying finding for osteomyelitis in the absence of a penetrative wound, recent surgery, biopsy or fracture. BACKGROUND Gas formation within joints and somatic soft tissues, diagnosed via radiological modalities is a well-known finding of degenerative diseases or infections. However, the presence of intraosseous gas, particularly in the extra-axial skeleton, is rare in the absence of a compound fracture or surgery. 1–3 Intraosseous gas is a pathognomonic sign for emphysematous osteomyelitis. 13 It is important to recognise this sign because rapid diagnosis and immediate aggressive treatment are necessary to prevent the fulminant course of the disease that can result in serious side effects or even death. 3 Here, we present a case of emphysematous osteomyelitis of the pubic bone diagnosed with CTand MRI. Culture results of the diagnostic specimens obtained from CT-guided drainage and surgical debridement confirmed a monobacterial Gram-negative infection.