Pumice stone sign

Last revised by Rohit Sharma on 30 Mar 2024

The pumice stone sign describes the distinctive imaging appearance of emphysematous osteomyelitis on CT described as clusters of greater than 3 distinct foci of intramedullary gas with irregularly irregular sizes ranging between 2 and 5 mm with resemblance to surface appearance of pumice stone. This sign is seen in 96% of cases of emphysematous osteomyelitis.1, 2

According to one study 1, most (79%) cases of emphysematous osteomyelitis were not associated with cortical destruction of bone unlike traditional osteomyelitis. Hence this sign may help in early diagnosis and treatment of this life-threatening condition. Adjacent soft tissue emphysema (79%) is also a key imaging feature.

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