Emphysematous Osteomyelitis: Novel Use of PET-MRI and a Review of Characteristic Imaging Findings

Introduction: Emphysematous Osteomyelitis (EO) is an extremely rare bone infection caused by gas-forming bacteria with few documented cases in the literature. Our study aims to high-light characteristic imaging features, including the novel use of positron emission tomography-magnetic resonance imaging (PET-MRI) in diagnosing this potentially fatal entity. Case: Radiography and computed tomography (CT) of the pelvis were performed due to complaints of persistent back pain in a 36-year-old male with a history of recent abdominal aorta surgery. Sacroiliac joint aspiration was performed, and a follow-up PET-MRI was subsequently performed. Results: Radiography and CT demonstrated bilateral sacroiliitis, osteonecrosis and EO in the bony pelvis. Left sacroiliac joint aspiration identified Staphylococcus aureus as the causative organism. PET-MRI revealed EO with left iliopsoas abscess and abdominal aortic graft infection. The patient's symptoms resolved following antibiotic therapy and image-guided abscess drainage. Conclusion: EO is a lethal variant of osteomyelitis with a dearth of published cases. Pertinent imaging characteristics of EO on radiography, CT and PET-MRI are discussed here, along with a review of the literature surrounding this rare condition.