Osteomyelitis and beyond
Musculoskeletal infections are a cause of considerable morbidity in children. Symptoms and signs are often nonspecific, and imaging is needed to define the anatomical location of infected tissue or fluid collections for diagnostic aspiration or biopsy. Prompt diagnosis and precise localization of the infection site has become even more imperative with the emergence and dissemination of highly invasive organisms such as community-acquired Staphylococcus aureus. Although radiography, bone scintigraphy and US continue to play a role, MRI is now the preferred imaging modality for definitive evaluation of pediatric musculoskeletal infections because of its capability of simultaneously assessing the osseous, articular and muscular structures without ionizing radiation exposure. This article focuses on the imaging characteristics of osteomyelitis, septic arthritis and pyomyositis and the differentiating features of potential mimics of infection.
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- "The interpretation of the images must utilise all of the available signs including the associated or adjacent synovial and soft tissue structures. Joint capsule inflammation and synovitis, as well as soft tissue swelling are important indicators, as they are often more prominent with sepsis (Yang et al. 2006; Jaramillo 2011; Guillerman 2013). Although the imaging modality of MRI is uniquely sensitive to the identification of osseous fluid, the fluid can also be a nonspecific finding (Fig 2). "
01/2014; 26(1). DOI:10.1111/eve.12118
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ABSTRACT: Early diagnosis and prompt treatment of acute osteomyelitis are of paramount importance in children because they can prevent irreversible bone damage. Magnetic resonance imaging (MRI) with its superior spatial resolution and lack of ionizing radiation is routinely preferred over bone scan for this purpose. Increased blood flow, hyperemia and focally increased tracer uptake shown by "three phase" bone scan are the typical scintigraphic findings of acute osteomyelitis. In addition, diffuse uptake along the shaft of long bones and focal "cold" lesions are two special features that may be highly suggestive of infective periostitis, soft tissue sepsis and subperiosteal abscess formation, due to the loose attachment of periosteum to bone during childhood. We present a case of complicated osteomyelitis in a child with inconclusive MRI correctly diagnosed on the basis of these special scintigraphic findings resulting in treatment change from double i.v. Vancomycin - Ceftriaxone scheme to surgical intervention.
08/2013; 33(2). DOI:10.1016/j.remn.2013.06.004
Available from: PubMed Central
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ABSTRACT: This paper presents a review of the current literature discussing topics of Charcot osteoarthropathy, osteomyelitis, diagnosing osteomyelitis, antibiotic management of osteomyelitis, and treatment strategies for management of Charcot osteoarthropathy with concurrent osteomyelitis.
Diabetic Foot and Ankle 10/2013; 4. DOI:10.3402/dfa.v4i0.21361
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