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Diagnostic Imaging 205

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Figure 3.23. Lateromedial (LM)
projections of the radius. Image (A) shows a
well‐defined, oval medullary sclerosis
adjacent to the endosteal surface of the
cranial mid‐diaphysis and a similar
elongated opacity adjacent to the caudal
endosteal surface at the same level. Image
(B) shows a diffused, irregular medullary
sclerosis affecting mostly the proximal and
mid thirds of the diaphysis. Nuclear medicine
exams showed increased radiopharmaceuti­
cal uptake in both cases, which is consistent
with enostosis‐like lesions. Source: Courtesy A B
of Dr. Jeremy D. Hubert.

Figure 3.24. Flexed dorsoproximal to dorsodistal oblique (flexed
D30Pr‐DDiO) projection of the distal row of carpal bones. Note the
sclerosis of the radial facet of the articular surface of the third carpal
bone with partial loss of the corticomedullary definition (arrows).

Chronic osteomyelitis may have the following radio­
graphic changes:
• Large cortical defects, some of which may be as large as Figure 3.25. Dorsolateral to plantaromedial oblique (D35L‐
1 cm in size and can also involve the medullary cavity. PlMO) projection of the tarsus, showing focal widening of the medial
Although rare, bone abscesses may appear as a geographic aspect of distal tibial physis with adjacent subchondral bone lysis
pattern of lysis represented by a single well‐defined and marked soft tissue thickening consistent with septic physitis.
medullary lytic area with surrounding sclerosis. 24,64 Source: Courtesy of Dr. Jeremy D. Hubert.