Extraosseous marrow fat: an MRI sign of acute aggressive osteomyelitis

MRI plays a critical role in the evaluation of osteomyelitis. However, MRI findings of osteomyelitis are not entirely specific and may mimic infiltrative tumors. We describe a case of extraosseous extruded medullary fat with a tiny transcortical tract caused by acute osteomyelitis, diagnosed by MRI and confirmed with intraoperative findings and pathology. Identification of extruded medullary fat is a specific MRI finding that aids in the differentiation of acute osteomyelitis from infiltrative tumor thereby preventing unnecessary biopsy and facilitating prompt diagnosis and initiation of appropriate treatment.