Hematogenous Osteomyelitis in Infants and Children: Imaging of a Changing Disease
Diego Jaramillo1, John P Dormans1, Jorge Delgado1
1From the Departments of Radiology (D.J., J.D.) and Pediatrics (J.W.S.G.), Children's Hospital of Philadelphia, Philadelphia, Pa; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa (D.J., J.W.S.G.); Department of Pediatric Orthopaedic Surgery, Texas Children's Hospital, Houston, Tex (J.P.D.); Department of Orthopedic Surgery, Baylor College of Medicine, Houston, Tex (J.P.D.); Department of Radiology and Medical Imaging, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (T.L.); and Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio (T.L.).
Insights
Hematogenous osteomyelitis in children is an increasing bone infection. Current imaging strategies must adapt to evolving disease patterns and complications for accurate diagnosis.
Area of Science:
- Pediatric Radiology
- Skeletal Imaging
- Infectious Disease Imaging
Background:
- Hematogenous osteomyelitis in children is a growing concern, marked by increased frequency, virulence, and soft-tissue involvement.
- Evolving clinical presentations and management strategies necessitate updated imaging approaches for pediatric osteomyelitis.
- Accurate imaging is crucial for identifying infection foci, extent, and drainable collections.
Purpose of the Study:
- To review the evolving imaging implications for pediatric hematogenous osteomyelitis.
- To correlate imaging findings with changes in epidemiology, anatomy, and pathophysiology.
- To provide guidance on imaging characteristics, complications, differential diagnoses, and age-based imaging extent.
Main Methods:
- Review of current literature and imaging practices for pediatric osteomyelitis.
- Emphasis on updated epidemiological data and pathophysiological insights.
- Discussion of imaging characteristics, complications, and differential diagnoses.
Main Results:
- The review highlights the need for imaging to detect single or multiple infection sites and collections.
- Specific imaging characteristics for various skeletal locations and complications are discussed.
- Age-appropriate imaging guidelines are presented to ensure adequate coverage.
Conclusions:
- The imaging approach to pediatric hematogenous osteomyelitis must evolve with the disease.
- Comprehensive imaging is essential for precise diagnosis, management, and understanding complications.
- Updated guidelines aid radiologists in optimizing imaging protocols for this condition.
Abstract:
In children, hematogenous osteomyelitis is an infection that primarily affects the most vascularized regions of the growing skeleton. The disease has increased in frequency, virulence, and degree of soft-tissue involvement. The change in clinical manifestations and management over the past 2 decades should be reflected in the current imaging approach to the disease. Imaging of infection must depict the location of a single focus or of multiple foci of involvement and the presence of drainable collections. This review provides an overview of the imaging implications directed by the changing epidemiology, the newer insights of anatomy and pathophysiology, the imaging characteristics with emphasis on specific locations and disease complications, and the differential diagnosis considerations. In addition, basic imaging guidelines for appropriate extent of area to image based on patient age are provided. © RSNA, 2017.
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