Dear Hilary,
I have seen this outcome on several occasions when the patient is not operated whatever the reason. To some extent, when acute and intense bone resorption develops in association with an infection, some unmineralized segment of bone may persist and may remineralized later with successful treatment. However, it is not because the radiological picture (partially) heals that the lesion heals. As a rule, pathogenic germs will remain active or quiescent, encapsulated in their biofilms (with or without signs of torpid infection). Better not to obtain an MRI at that moment as it may underestimate the lesion (although it can also be very abnormal). Later on, whatever we do, the infection will reappear.. unfortunately.
This is why surgery is usually performed; it is the only way to get rid of the germs, active or quiescent.
regards
bruno
Le 29-09-23 à 18:33, hilary umans a écrit :
The lateral shows deep plantar ulceration, there is severe 1st MTP joint narrowing and periarticular osteopenia…I was ready to report as septic arthritis and questionable osteomyelitis
Then I realized there were prior XRs
There’s dramatically improved mineralization today, with restored cortical contours
I am surprised that something that looked like this was treated with antibiotics…I have not known that to happen…typically, I thought, there would have been transmetatarsal amputation
Now I don’t know if we’re coming or going
Is there current active infection, or is it all an improving picture
How would you report this?
I am not inclined to recommend MRI, because I cannot know what is active or resolving infection….except maybe to see if there is abscess….unless there is some other way it might help?
What do you think?Hilary
