case_images: PMC11193920_01
case_images: (A) Anterior posterior and (B) lateral radiographs of the right knee joint at the initial visit showing osseous lesion at the distal metaphysis.
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case_images: A knee X-ray was done, and showed an osseous lesion at the distal metaphysis (Figure 1).
case_images: Right knee magnetic resonance imaging (MRI) with contrast showing an osseous lesion at the distal metaphysis with growth plate and epiphyseal involvement along with cortical breech and fistula formation. (A) Sagittal cut T2 magnetic resonance imaging (MRI) shows effusion in knee joint; (B) Sagittal cut T2 MRI shows lesion in metaphyseal area of distal femur lateral side; (C) Coronal cut lesion in distal femur metaphyseal area affecting the physis and localized collection in gutter; (D) Axial cut shows knee effusion.
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case_images: (A) Anterior posterior and (B) lateral radiographs of the right knee joint at the follow-up showing an increase the size of the lesion and a well-defined lytic lesion on the metaphyseal area of the distal femur, crossing the physis toward epiphysis.
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case_images: A new X-ray were done (Figures 3).
case_images: Postoperatively following a second incision and drainage.
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case_images: He underwent incision and drainage again, and culture and tissues with a cheese-like appearance were sent for staining for acid-fast bacilli (Figure 4).