Musculoskeletal Imaging

Chronic recurrent multifocal osteomyelitis

a subacute and chronic osteomyelitis of unknown cause with multiple and symmetric alterations, frequently involving the metaphyses of the bones in the lower extremity and the medial ends of the clavicles in paediatric patients. This condition is also known as SAPHO syndrome (from the findings of synovitis, acne, pustulosis, hyperostosis and osteitis). Patients commonly exhibit pain, tenderness and swelling. In some cases, osteolysis with intense sclerosis is noted. Massive hyperostosis may be seen in some patients, suggesting a diagnosis of fibrous dysplasia, Paget's disease or sarcoma. The peculiar features of this variety of osteomyelitis include a protracted clinical course, symmetric bone involvement, and a predilection for the metaphyseal regions of tubular bones, and involvement of the clavicle. Pustular or other skin lesions may be observed in this condition.

DR