. The American journal of roentgenology, radium therapy and nuclear medicine . i; , ^„> aureus. Acute cast of osteomyelitis of three to four weeksduration. Note periostitis in lower third of femur. areas of destruction coming in contact withthe living bone cause the normal bone tobecome inflamed and ulcerated about themargins of the dead bone, helping in theformation of sequestra. When the infectious process startsbeneath the periosteum, the infectionspreads more easily into the periosteum,and the cortex becomes involved moreslowly, due to its density. This type ischaracterized by
. The American journal of roentgenology, radium therapy and nuclear medicine . i; , ^„> aureus. Acute cast of osteomyelitis of three to four weeksduration. Note periostitis in lower third of femur. areas of destruction coming in contact withthe living bone cause the normal bone tobecome inflamed and ulcerated about themargins of the dead bone, helping in theformation of sequestra. When the infectious process startsbeneath the periosteum, the infectionspreads more easily into the periosteum,and the cortex becomes involved moreslowly, due to its density. This type ischaracterized by marked periosteal prolif-eration, accompanied by very small areasof destruction. In chronic osteomyelitis the .v-ray showsa pathological process confined to the shaft, which may include a large partof the bone involved. The original bone isoften thickened and irregular, due to thedeposit of successive layers of periostealbone on the cortex, often causing themedullary canal to appear cortical bone may show small areas ofdestruction, as illustrated by irregular. Fig. 4. Chronic osteomyelitis. Extensive periostealinvolvement of the lower end of the femur, nearlyto the middle of the shaft. patches of decreased density due to thesmall areas of infection remaining. Periosteal Changes Observed in Tuberculo-sis. In this country tuberculosis of theshaft of the long bones has been con-sidered a \ ery rare condition. Radiographi-cally the condition appears as irregular,slight or extensive areas of destruction inthe cancellous bone or the medullarycanal. The periosteum is invoUed only asthe result of secondary infection. For thisreason, tuberculous lesions producingperiosteal reactions are generally indistin-guishable from osteomyelitis of pyogenicorigin. 596 Roentgen-Ray Study of Non-Luetic Periosteal Bone Lesions In children the short bones of the handsand feet are prone to tuberculosis. Thecondition appears on the roentgenogramas irregular punched-out areas in themedulla
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