Abscess pulsatility: a sonographic sign of osteomyelitis

Area of Science:

• Medical imaging
• Orthopedics
• Infectious diseases

Background:

• Early diagnosis and treatment of acute osteomyelitis are crucial for improving patient outcomes.
• Sonography is a valuable tool for evaluating osteomyelitis, detecting signs like soft tissue inflammation, periosteal changes, and subperiosteal abscesses.

Purpose of the Study:

• To highlight a unique sonographic finding in a case of osteomyelitis.
• To emphasize the diagnostic utility of detecting pulsatile fluid flow near bone.

Main Methods:

• A case presentation of a 68-year-old female with worsening leg pain initially diagnosed as cellulitis.
• Point-of-care ultrasound revealed bidirectional pulsatile fluid flow through a cortical defect, confirmed with Doppler.
• Diagnosis of osteomyelitis was established and treated with antibiotics and surgical intervention.

Main Results:

• Sonography identified a unique finding of pulsatile fluid flow within an abscess adjacent to bone.
• This pulsatility, potentially representing blood or pseudoflow, highlighted a cortical defect.
• The finding led to the diagnosis of osteomyelitis.

Conclusions:

• The sonographic observation of pulsatile flow in an abscess near bone suggests potential communication with the medullary cavity.
• This distinctive Doppler signal can serve as an early indicator for osteomyelitis, prompting further investigation.