{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,26]],"date-time":"2026-04-26T04:51:57Z","timestamp":1777179117694,"version":"3.51.4"},"reference-count":22,"publisher":"Springer Science and Business Media LLC","issue":"1","content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["World J Surg Onc"],"published-print":{"date-parts":[[2013,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The clinical symptoms and radiographic appearance of osteomyelitis can mimic those of bone tumors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We reviewed 10 patients with osteomyelitis of the femur who were initially diagnosed as having bone tumors and were subsequently transferred to our institution.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Nocturnal pain of moderate intensity occurred in seven patients, and all 10 patients had elevated C-reactive protein levels. The radiographic findings included the following: a permeative, moth-eaten osteolytic lesion in six patients, an osteolytic lesion with sclerotic borders in three patients, and cortical destruction with pathological fracture in one patient. Magnetic resonance imaging was performed for eight patients, and only one had a positive penumbra sign. All patients underwent a surgical biopsy to confirm the final diagnosis for histological analysis and cultures.<jats:italic>Klebsiella pneumoniae<\/jats:italic>was detected in six patients and<jats:italic>Staphylococcus aureus<\/jats:italic>, the most common organism in osteomyelitis, was detected in three. Recurrence of infection occurred in five patients following debridement surgery; of these three had a<jats:italic>Klebsiella pneumoniae<\/jats:italic>infection. All patients received antibiotic treatment for an average of 20.4 weeks (range, 4 to 44) and surgical treatment an average of 1.8 times (range, 1 to 4). At the final follow-up, all patients were fully recovered with no signs of infection.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>When used in combination, clinical examinations, laboratory data, and radiographic findings can reliably distinguishing osteomyelitis from bone tumors.<\/jats:p><\/jats:sec>","DOI":"10.1186\/1477-7819-11-283","type":"journal-article","created":{"date-parts":[[2013,10,22]],"date-time":"2013-10-22T21:44:59Z","timestamp":1382478299000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":31,"title":["Osteomyelitis of the femur mimicking bone tumors: a review of 10 cases"],"prefix":"10.1186","volume":"11","author":[{"given":"Po-Yen","family":"Huang","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Po-Kuei","family":"Wu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cheng-Fong","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fang-Tsai","family":"Lee","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hung-Ta","family":"Wu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chien-Lin","family":"Liu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tain-Hsiung","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wei-Ming","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2013,10,22]]},"reference":[{"key":"1476_CR1","doi-asserted-by":"publisher","first-page":"928","DOI":"10.1080\/02841850802241809","volume":"49","author":"S Shimose","year":"2008","unstructured":"Shimose S, Sugita T, Kubo T, Matsuo T, Nobuto H, Ochi M: Differential diagnosis between osteomyelitis and bone tumors. Acta Radiol. 2008, 49: 928-933. 10.1080\/02841850802241809.","journal-title":"Acta Radiol"},{"key":"1476_CR2","doi-asserted-by":"publisher","first-page":"29","DOI":"10.2165\/00003495-199345010-00004","volume":"45","author":"DR Dirschl","year":"1993","unstructured":"Dirschl DR, Almekinders LC: Osteomyelitis: common causes and treatment recommendations. Drugs. 1993, 45: 29-43.","journal-title":"Drugs"},{"key":"1476_CR3","doi-asserted-by":"publisher","first-page":"584","DOI":"10.1302\/0301-620X.94B5.28523","volume":"94","author":"J Dartnell","year":"2012","unstructured":"Dartnell J, Ramachandran M, Katchburian M: Haematogenous acute and subacute paediatric osteomyelitis: a systematic review of the literature. J Bone Joint Surg Br. 2012, 94: 584-595. 10.2106\/JBJS.J.01073.","journal-title":"J Bone Joint Surg Br"},{"key":"1476_CR4","doi-asserted-by":"publisher","first-page":"587","DOI":"10.1016\/S0009-9260(98)80150-5","volume":"53","author":"AC Grey","year":"1998","unstructured":"Grey AC, Davies AM, Mangham DC, Grimer RJ, Ritchie DA: The \u201cpenumbra sign\u201d on T1-weighted MR imaging in subacute osteomyelitis: frequency, cause and significance. Clin Radiol. 1998, 53: 587-592. 10.1016\/S0009-9260(98)80150-5.","journal-title":"Clin Radiol"},{"key":"1476_CR5","doi-asserted-by":"publisher","first-page":"249","DOI":"10.1097\/01241398-198208000-00003","volume":"2","author":"JM Roberts","year":"1982","unstructured":"Roberts JM, Drummond DS, Breed AL, Chesney J: Subacute hematogenous osteomyelitis in children: a retrospective study. J Pediatr Orthop. 1982, 2: 249-254. 10.1097\/01241398-198208000-00003.","journal-title":"J Pediatr Orthop"},{"key":"1476_CR6","doi-asserted-by":"publisher","first-page":"314","DOI":"10.1016\/S0899-7071(02)00440-0","volume":"26","author":"T Marui","year":"2002","unstructured":"Marui T, Yamamoto T, Akisue T, Nakatani T, Hitora T, Nagira K, Yoshiya S, Kurosaka M: Subacute osteomyelitis of long bones: diagnostic usefulness of the \u201cpenumbra sign\u201d on MRI. Clin Imaging. 2002, 26: 314-318. 10.1016\/S0899-7071(02)00440-0.","journal-title":"Clin Imaging"},{"key":"1476_CR7","doi-asserted-by":"publisher","first-page":"1268","DOI":"10.1007\/s00330-004-2435-9","volume":"15","author":"AM Davies","year":"2005","unstructured":"Davies AM, Grimer R: The penumbra sign in subacute osteomyelitis. Eur Radiol. 2005, 15: 1268-1270. 10.1007\/s00330-004-2435-9.","journal-title":"Eur Radiol"},{"key":"1476_CR8","doi-asserted-by":"publisher","first-page":"417","DOI":"10.1007\/s00256-006-0267-1","volume":"36","author":"B McGuinness","year":"2007","unstructured":"McGuinness B, Wilson N, Doyle AJ: The \u201cpenumbra sign\u201d on T1-weighted MRI for differentiating musculoskeletal infection from tumour. Skeletal Radiol. 2007, 36: 417-421. 10.1007\/s00256-006-0267-1.","journal-title":"Skeletal Radiol"},{"key":"1476_CR9","doi-asserted-by":"publisher","first-page":"763","DOI":"10.1007\/s002470000318","volume":"30","author":"T P\u00f6yhi\u00e4","year":"2000","unstructured":"P\u00f6yhi\u00e4 T, Azouz EM: MR imaging evaluation of subacute and chronic bone abscesses in children. Pediatr Radiol. 2000, 30: 763-768. 10.1007\/s002470000318.","journal-title":"Pediatr Radiol"},{"key":"1476_CR10","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1001\/archsurg.1974.01360010050012","volume":"109","author":"ME Cabanela","year":"1974","unstructured":"Cabanela ME, Sim FH, Beabout JW, Dahlin DC: Osteomyelitis appearing as neoplasms. A diagnostic problem. Arch Surg. 1974, 109: 68-72. 10.1001\/archsurg.1974.01360010050012.","journal-title":"Arch Surg"},{"key":"1476_CR11","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1097\/00003086-198912000-00027","volume":"249","author":"H Mirels","year":"1989","unstructured":"Mirels H: Metastatic disease in long bones. A proposed scoring system for diagnosing impending pathologic fractures. Clin Orthop Relat Res. 1989, 249: 256-264.","journal-title":"Clin Orthop Relat Res"},{"key":"1476_CR12","doi-asserted-by":"publisher","first-page":"243","DOI":"10.1007\/s002640050159","volume":"21","author":"P Cottias","year":"1997","unstructured":"Cottias P, Tomeno B, Anract P, Vinh TS, Forest M: Subacute osteomyelitis presenting as a bone tumour. A review of 21 cases. Int Orthop. 1997, 21: 243-248. 10.1007\/s002640050159.","journal-title":"Int Orthop"},{"key":"1476_CR13","first-page":"283","volume":"25","author":"L Schulte","year":"1973","unstructured":"Schulte L: Primary subacute pyogenic osteomyelitis in children. A study of four cases. Arch Chir Neerl. 1973, 25: 283-291.","journal-title":"Arch Chir Neerl"},{"key":"1476_CR14","doi-asserted-by":"publisher","first-page":"316","DOI":"10.1056\/NEJM197002052820606","volume":"282","author":"FA Waldvogel","year":"1970","unstructured":"Waldvogel FA, Medoff G, Swartz MN: Osteomyelitis: a review of clinical features, therapeutic considerations and unusual aspects. 3. Osteomyelitis associated with vascular insufficiency. N Engl J Med. 1970, 282: 316-322. 10.1056\/NEJM197002052820606.","journal-title":"N Engl J Med"},{"key":"1476_CR15","doi-asserted-by":"publisher","first-page":"636","DOI":"10.1093\/clind\/15.4.636","volume":"15","author":"HN Ukwu","year":"1992","unstructured":"Ukwu HN, Graham BS, Latham RH: Acute pubic osteomyelitis in athletes. Clin Infect Dis. 1992, 15: 636-638. 10.1093\/clind\/15.4.636.","journal-title":"Clin Infect Dis"},{"key":"1476_CR16","doi-asserted-by":"publisher","first-page":"693","DOI":"10.7326\/0003-4819-75-5-693","volume":"75","author":"RS Holzman","year":"1971","unstructured":"Holzman RS, Bishko F: Osteomyelitis in heroin addicts. Ann Intern Med. 1971, 75: 693-696. 10.7326\/0003-4819-75-5-693.","journal-title":"Ann Intern Med"},{"key":"1476_CR17","doi-asserted-by":"publisher","first-page":"296","DOI":"10.1542\/peds.101.2.296","volume":"101","author":"MW Burnett","year":"1998","unstructured":"Burnett MW, Bass JW, Cook BA: Etiology of osteomyelitis complicating sickle cell disease. Pediatrics. 1998, 101: 296-297. 10.1542\/peds.101.2.296.","journal-title":"Pediatrics"},{"key":"1476_CR18","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1128\/jcm.25.2.251-254.1987","volume":"25","author":"RC Noble","year":"1987","unstructured":"Noble RC, Overman SB: Propionibacterium acnes osteomyelitis: case report and review of the literature. J Clin Microbiol. 1987, 25: 251-254.","journal-title":"J Clin Microbiol"},{"key":"1476_CR19","doi-asserted-by":"publisher","first-page":"1021","DOI":"10.1001\/archinte.162.9.1021","volume":"162","author":"R-W Tsay","year":"2002","unstructured":"Tsay R-W, Siu LK, Fung C-P, Chang FY: Characteristics of bacteremia between community-acquired and nosocomial Klebsiella pneumoniae infection: risk factor for mortality and the impact of capsular serotypes as a herald for community-acquired infection. Arch Intern Med. 2002 May 13, 162: 1021-1027. 10.1001\/archinte.162.9.1021.","journal-title":"Arch Intern Med"},{"key":"1476_CR20","doi-asserted-by":"publisher","first-page":"322","DOI":"10.1097\/00000441-200606000-00006","volume":"331","author":"SP Dourakis","year":"2006","unstructured":"Dourakis SP, Alexopoulou A, Metallinos G, Thanos L, Archimandritis AJ: Pubic osteomyelitis due to Klebsiella pneumoniae in a patient with diabetes mellitus. Am J Med Sci. 2006, 331: 322-324. 10.1097\/00000441-200606000-00006.","journal-title":"Am J Med Sci"},{"key":"1476_CR21","doi-asserted-by":"publisher","first-page":"263","DOI":"10.3109\/00365549109023410","volume":"23","author":"CW Chen","year":"1991","unstructured":"Chen CW, Yang CJ, Huang JJ, Chuang YC, Young C: Gas-forming vertebral osteomyelitis in diabetic patients. Scand J Infect Dis. 1991, 23: 263-265. 10.3109\/00365549109023410.","journal-title":"Scand J Infect Dis"},{"key":"1476_CR22","doi-asserted-by":"publisher","first-page":"299","DOI":"10.1016\/0195-6701(94)90117-1","volume":"27","author":"KH Lee","year":"1994","unstructured":"Lee KH, Hui KP, Tan WC, Lim TK: Klebsiella bacteraemia: a report of 101 cases from National University Hospital, Singapore. J Hosp Infect. 1994, 27: 299-305. 10.1016\/0195-6701(94)90117-1.","journal-title":"J Hosp Infect"}],"container-title":["World Journal of Surgical Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/1477-7819-11-283.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,3,9]],"date-time":"2022-03-09T23:34:57Z","timestamp":1646868897000},"score":1,"resource":{"primary":{"URL":"https:\/\/wjso.biomedcentral.com\/articles\/10.1186\/1477-7819-11-283"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2013,10,22]]},"references-count":22,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2013,12]]}},"alternative-id":["1476"],"URL":"https:\/\/doi.org\/10.1186\/1477-7819-11-283","relation":{},"ISSN":["1477-7819"],"issn-type":[{"value":"1477-7819","type":"electronic"}],"subject":[],"published":{"date-parts":[[2013,10,22]]},"assertion":[{"value":"27 July 2013","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 September 2013","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 October 2013","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}}],"article-number":"283"}}