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Hematogenous pelvic osteomyelitis in children. Clinical correlates of newer scanning methods
Insights
Early recognition of hematogenous pelvic osteomyelitis in children is crucial. Advanced imaging techniques like gallium citrate Ga 67 and technetium Tc 99m oxidronate scintigraphy aid in prompt diagnosis, preventing complications.
Area of Science:
- Pediatric Orthopedics
- Pediatric Infectious Diseases
- Medical Imaging
Background:
- Hematogenous pelvic osteomyelitis is a serious bone infection in children.
- Diagnosis can be challenging due to non-specific symptoms and normal initial X-rays.
Purpose of the Study:
- To review the clinical presentation, diagnostic methods, and outcomes of pediatric pelvic osteomyelitis.
- To highlight the role of advanced imaging in early diagnosis and management.
Main Methods:
- Retrospective review of 18 children with hematogenous pelvic osteomyelitis.
- Analysis of clinical symptoms, laboratory findings, and imaging results (plain roentgenograms, gallium citrate Ga 67, technetium Tc 99m oxidronate scintigraphy, computed tomography).
Main Results:
- Common symptoms include gait disturbance (94%) and hip pain (61%); many patients were afebrile (61%).
- Elevated erythrocyte sedimentation rate (94%) was common, while leukocytosis was infrequent.
- Radionuclide scintigraphy and computed tomography showed high diagnostic accuracy, unlike initial plain roentgenograms.
Conclusions:
- Delayed diagnosis of pelvic osteomyelitis in children can lead to complications.
- Advanced imaging techniques are essential for prompt diagnosis and effective treatment.
- Early recognition and management are key to preventing complications in pediatric pelvic osteomyelitis.
Abstract:
The records of 18 children with hematogenous pelvic osteomyelitis seen over a four-year period were reviewed. The mean age of the patients was 7.8 years and their most common presenting symptoms were gait disturbance (present in 94%) and pain about the hip (61%) with only mild limitation of motion; 11 (61%) of 18 patients were afebrile at presentation. Although leukocytosis was uncommon, the erythrocyte sedimentation rate was almost always elevated (greater than 40 mm/hr in 94% of the patients). While initial plain roentgenograms were usually normal, gallium citrate Ga 67 and technetium Tc 99m oxidronate scintigrams were abnormal in all patients who underwent these studies. Computed tomography proved to be a useful complementary study to radionuclide scintigraphy, yielding positive findings in nine of 11 cases. Patients presented for medical care a median of 2.5 days after the onset of symptoms, whereas a longer period of time (median, 7.5 days) was required to establish the correct diagnosis after presentation for care. The only observed complications occurred in two patients in whom there was significant delay in institution of therapy. Prevention of complications from pelvic osteomyelitis lies in early recognition and appropriate treatment of the disease. In our experience, newer imaging techniques facilitate prompt diagnosis.