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Smallpox: Osteomyelitis Variolosa and Smallpox Pneumonia

Imaging Diagnosis

The earliest radiographic finding is soft tissue swelling around the joints, and at this stage the pox on the skin occasionally may be recognized radiologically (Fig. 40.3). Associated with the swelling, there will be localized osteoporosis and, in some patients, bone destruction in the metaphysis; this is most clearly defined on the epiphyseal side. Bone may be affected without joint involvement, but there is usually fluid in the joint with widening of the joint space.

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Fig. 40.3A-F The development of smallpox osteomyelitis at the elbow joints. (A) Marked soft tissue swelling and minimal metaphyseal bone destruction in the lower end of the humerus and upper end of the radius. (B) The metaphyseal lesions in the ulna and radius are more clearly shown and there is a periosteal reaction about all three bones of the elbow. (C) The periosteal reaction about the lower end of the humerus is more advanced. The metaphyseal lesions are visible in all three bones. (D) Numerous foci of bone destruction are noted in the metaphyses as well as several translucent areas within the ends of the diaphyses of both the radius and the ulna. (E) More extensive destruction is seen in the metaphyses and shafts of all three bones of the elbow and there is a marked periosteal reaction about the ulna and lower end of the humerus. The joint is beginning to subluxate. (F) There is disruption of the joint, new bone formation, periosteal elevation, and thickening about the distal humerus and along the entire shafts of the radius and ulna, with central areas of bone destruction. This joint will eventually fuse (A- C courtesy of Dr. J.C. Davidson and Dr. P.E. S. Palmer: Journal of Bone and Joint Surgery, 1963).

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Copyright: Palmer and Reeder