B0080

Left femur

On the distal third of the shaft are two large cloacae that drain from the medullary cavity to both the anterior and posterior surfaces. The posterior cloaca measures 46mm proximodistal x 26mm mediolateral and has smooth margins.  Within the distal half of the cloaca is a large irregular necrotic bone fragment (sequestrum) adhering to the margin, which measures 23mm proximodistal x26mm mediolateral.    There is also small sequestrum adhering to the superior margin.  The cloaca on the anterior surface measures 15mm proximodistal x 13mm mediolateral and has smooth rounded margins.  The cloacae are surrounded by a large involucrum that extends the distal two thirds of the shaft. The involucrum consists of a mixture of smooth and irregular compact bone deposited on the original cortical surface and highly disorganised spicules of new compact bone on the posterior surface.  On the lateral side of the posterior surface is a large disorganised extension of bone that has two perforating channels for nervous and vascular supply.  The majority of the new compact bone on the anterior surface is smooth. However, there are areas of irregular deposits of nodular compact bone.  There is a faint trace of a fracture line running superolaterally to inferomedially (confirmed by radiographs).  This is osteomyelitis secondary to a compact fracture.

Co-existing Pathology:

There is extensive osteophyte formation creating a bony ring surrounding the distal joint surface.

Disease Classification:

Infective-non-specific-osteomyelitis

Traumatic-accidental-fractures

Degenerative joint disease-osteophytosis

b000300

Right os coxae

There is spiculated new compact bone formation on the auricular surface, which has an irregular joint surface contour.  Superoposterior to this, there is an elliptical area of bone destruction, which has smooth margins and that interrupts a portion of the posterior iliac crest.  There is a channel of reactive new compact bone and destructive porosity between the auricular surface to the inferior margin of the destructive lesion. These changes are evidence of tuberculosis of the sacroiliac joint. On the gluteal surface, there is a large, but localised, area of pitting and spiculated new compact bone.

Disease Classification:

Infective-specific-bacterial-tuberculosis

B001000

Fourth and Fifth lumbar vertebrae

There is a destructive lesion on the mid-section of the anterior surface of the body with spiculated new compact bone at its base.  There is ossification of the anterior longitudinal ligament on the left side (less extensive than B0011) joining that of the fourth lumbar vertebra.  This bony bridge is not fused together, but is a pseudo joint allowing for some movement.  On the right side of the body there is a mixture of new woven bone and ossified ligament.  Along with the changes in the fourth lumbar vertebra, this is possible evidence of a psoas abscess associated with tuberculosis.

Disease Classification:

Infective-specific-bacterial-tuberculosis

About these ads