Keywords:
MR, CT, Conventional radiography, Diagnostic procedure, Infection
Authors:
G. Freire1, C. D. O. Mira1, M. H. Valentim2, J. Paiva1, L. Gargaté1, P. D. Afonso3; 1Loures/PT, 2Lisboa/PT, 3Lisbon/PT
DOI:
10.26044/essr2019/P-0063
Background
Osteomyelitis is an infection of bone,
bone marrow and surrounding soft tissue.
It is subdivided according to the time of onset and is classified in acute (<14 days),
subacute (2-6 weeks) and chronic (>6 weeks).1,2
In children,
the most frequent route of infection is hematogenous spread.
Direct spread by penetration after trauma is less common,
and typically occurs in older children,
with S.
aureus being the most frequent pathogen involved.3 The number of Methicillin-resistant S.
aureus (MRSA) infections has increased in the recent past and this organism is more virulent and prone to myositis and abscess formation.4
Neonates are at greater risk for infection due to immaturity of the immune system and approximately half of the cases occur in children younger than 5 years-old.1 Common risk factors include history of trauma,
sickle cell disease,
presence of chronic vascular lines and sepsis.
3
Osteomyelitis can be a challenging diagnosis in pediatrics,
as symptoms are non-specific and it is difficult to recognize in the early stages of disease.
Imaging studies are essential for clinical guidance,
allowing early diagnosis and successful outcome,
as complications markedly increase when treatment is delayed.
A late diagnosis can therefore lead to septic arthritis,
subperiosteal abscess,
pyomyositis,
deep vein thrombosis,
physeal damage with subsequent permanent impairment or deformity,
chronic infection,
septicemia,
multiple organ failure and even death.5