Diagnostic imaging of pediatric hematogenous osteomyelitis: lessons learned from a multi-modality approach

Pediatric hematogenous osteomyelitis may present highly variable radiological expression, which is influenced by the age and condition of the patient, the virulence of the causative agent, the stage of the disease, or the selected imaging tool. Given the multiplicity of available modalities and the multi-faceted nature of the process, purposeful imaging of pediatric hematogenous osteomyelitis may be difficult. In order to avoid diagnostic delays and complications, familiarity with the variable expression of the disease and assumption of the potentialities, roles and limitations of the various imaging modalities is required. In this pictorial essay we review, illustrate and discuss, in a multi-modality approach, the various radiological patterns that may be found in pediatric hematogenous osteomyelitis, with emphasis on strategies, staging, uncommon distribution patterns, and differential diagnosis.