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Multifocal osteomyelitis in childhood. Review by radionuclide bone scan
1Department of Nuclear Medicine, Childrens Hospital, Sydney, NSW, Australia.
Abstract:
Multifocal osteomyelitis is considered an uncommon complication of acute osteomyelitis. Over a 3-year period, 136 infants and children who had a final diagnosis of acute osteomyelitis were reviewed, and multifocal osteomyelitis was detected in 27 (19%) patients. The major age peak of acute osteomyelitis was between 6 weeks and 3 years (46%). Two age peaks were found for multifocal disease-less than 6 weeks (38%), and 9 to 12 years (44%). Three patients with multifocal disease had septicemia and photon-deficient areas on bone scans. Another adolescent group had nonspecific bone and joint pain that in some cases persisted for more than 3 months and were finally diagnosed as multifocal osteomyelitis. Organisms were isolated in 15/27 (56%). Multifocal osteomyelitis is well recognized in the neonatel age group. However, it occurs more commonly than previously described in older patients. This higher incidence can most likely be attributed to the higher use of the radionuclide bone scan early in the disease and the high sensitivity of the scan for the detection of osteomyelitis.
Insights
Multifocal osteomyelitis, an uncommon complication of acute osteomyelitis, affects infants and older children. Increased use of bone scans reveals its higher incidence in various age groups.
Area of Science:
- Pediatric Infectious Diseases
- Musculoskeletal Infections
- Diagnostic Imaging
Background:
- Multifocal osteomyelitis is an uncommon complication of acute osteomyelitis.
- Previous understanding suggested it primarily affects neonates.
Purpose of the Study:
- To determine the incidence and age distribution of multifocal osteomyelitis in children.
- To evaluate the role of radionuclide bone scans in diagnosing multifocal osteomyelitis.
Main Methods:
- Retrospective review of 136 pediatric patients diagnosed with acute osteomyelitis over 3 years.
- Analysis of patient demographics, clinical presentation, diagnostic findings (including bone scans), and microbiological data.
Main Results:
- Multifocal osteomyelitis was detected in 27% (19) of patients.
- Two distinct age peaks for multifocal disease were identified: neonates (<6 weeks) and older children (9-12 years).
- Radionuclide bone scans, due to high sensitivity, likely contribute to the increased detection of multifocal osteomyelitis.
Conclusions:
- Multifocal osteomyelitis occurs more frequently in older children than previously recognized.
- Early and sensitive bone scan imaging is crucial for diagnosing multifocal osteomyelitis across pediatric age groups.