Imaging of Osteomyelitis in Children
Section snippets
Physiopathology
Osteomyelitis is by definition an infection of the bone and bone marrow.56 Infective or suppurative osteitis is limited to the cortical bone. An infective periostitis refers to the contamination of the periosteal cloak around the bone. Septic (infectious) arthritis, when a joint is involved, is a surgical emergency in children. Three different clinical entities may be identified: (1) acute, (2) subacute, and (3) chronic osteomyelitis. This nosology relies on many factors, among which the host
Acute Osteomyelitis.
Typical clinical signs include the triad of fever, local pain, and tenderness. In many cases, only an elevated sedimentation rate and local tenderness are present. Bone destruction is radiographically evident about 2 weeks after the onset of the infection. Characteristic features are the metaphyseal location in the long bones and the periosteal reaction. The latter may be seen, however, in histiocytosis, leukemia, trauma, or Ewing's sarcoma (Figs. 5 and 6).2, 5, 9, 40
Subacute Osteomyelitis.
It has a more insidious
COMPLICATIONS OF OSTEOMYELITIS
Secondary septic (infectious) arthritis and possible dislocation occur when the infected metaphysis is intracapsular as is the case for the hip. A recent survey has shown an appreciable incidence of joint involvement in limb osteomyelitis with a 33% incidence of adjacent septic (infectious) joint.53 Pathologic fracture may occur because of the osteopenic early bone destruction or the insufficient involucrum formation.
Growth disturbances include either lengthening of the bone, the result of
Hand.
The infection usually spreads from a puncture wound by three routes: (1) tendon sheath, (2) fascial planes, and (3) lymphatics. S aureus is commonly but not always the causative agent (Fig. 8).
Foot.
Pseudomonas aeruginosa infection involves the calcaneus in cases of puncture wounds and bone changes occur along the inferior cortical margin. Hematogenous osteomyelitis of the calcaneus prefers to develop close to the posterior half of the bone in the metaphyseal equivalent region.55
Metaphyseal Equivalent Osteomyelitis.
Sites of involvement
SUMMARY
Imaging approach to osteomyelitis in children should aim toward a timely and accurate diagnosis in view of the need for prompt therapy to prevent sequelae. One must take advantage of the specific value of each imaging modality and adopt a strategy that works best for a given child in a given institution.
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2018, Seminars in Nuclear MedicineCitation Excerpt :Plain films are notoriously insensitive in the detection of acute osteomyelitis. While soft tissue swelling may be seen shortly after the onset of symptoms, changes in bone are rarely appreciated before 7-10 days and are further delayed when disease involves the spine or pelvis.64,65 However, plain films are often used to exclude other diagnostic entities such as tumor or trauma.56
Benign Bone Conditions That May Be FDG-avid and Mimic Malignancy
2017, Seminars in Nuclear MedicineNuclear Medicine Imaging in Pediatric Infection or Chronic Inflammatory Diseases
2017, Seminars in Nuclear MedicineCitation Excerpt :Therefore, further diagnostic imaging is usually required, and each modality has its advantages and limitations. Plain radiographs are often the first imaging choice, but bone destruction only becomes apparent 2-3 weeks after the symptom onset.14 A negative plain radiograph on admission does not rule out OM, but can exclude other pathologic conditions.15
Address reprint requests to Kamaldine Oudjhane, MD, MSc, Montréal Children's Hospital, Room C-312, 2300 Tupper Street, Montréal, QC, H3H 1P3 Canada
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Department of Radiology, Faculty of Medicine, McGill University Health Centre, Montréal Children's Hospital; and Shriners Hospital for Children, Montréal, Québec, Canada