Features of clinical and morphological picture and diagnostics of "atypical forms" of hematogenous osteomyelitis of long bones

Abstract

In recent years one observes increased frequency of hematoge-nous osteomyelitis (HO) with atypical clinical course diagnostics of which is difficult and morphogenesis and pathogenesis is not completely clear. Objective: on the basis of clinical examination of patients with clinical, laboratory, visual and pathomorpho­logical methods to determine the features of chronic GO (CHO) with atypical clinical course particularly Brodie abscess (BA) and Garre's sclerosing osteomyelitis (GSO). Methods: The clini­cal course, pathologic features, the results visualizing methods of examination and complex treatment of patients with BA (26) and GSO (10). Results: In cases of AB intraosseous inflammatory focus with relatively sharp edges exists for many months and even years. At pathomorphological examination there were revealed destructive lesions with the capsule, consisting of internal, fibrous, and bone membranes. While GSO a significant portion of the bone involved into the inflammatory process until subtotal lesion. In the amended cortex numerous areas of osteonecrosis are noted. Either in them or in periosteal and endosteal regenerates polymorphic resorptive cavities filled as well as intertrabecular spaces with mellow fibrous or immature fibrous tissue with mononuclear inflammatory plasmocytic infiltrates are located. BA belongs to the destructive form of CHO with predominantly productive-infiltrative inflammation of high activity in the focal capsule, and GSO — to fibrozive and fibrozive with mikroabscessing. Conclu­sion: Definitions for atypical forms of HO (subacute, primary chronic, primary subacute) relate to the clinical features of its course. Morphologically foci of latent HO correspond to the basic forms of osteomyelitic foci: destructive, fibrozive, and fibrozive with mikroabscessing.