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Acute haematogenous osteomyelitis in children - the reliability of skeletal scintigraphy
Insights
Bone scans aid early osteomyelitis diagnosis in children. However, a negative scan doesn't rule out the condition, and "cold" lesions require prompt attention.
Area of Science:
- Pediatric Imaging
- Nuclear Medicine
- Skeletal System Imaging
Background:
- Acute osteomyelitis diagnosis in children presents challenges.
- Early detection is crucial for effective treatment and preventing complications.
Observation:
- Thirty-nine bone scans were analyzed in children aged 1 week to 14 years with suspected acute osteomyelitis.
- Most scans were performed within the first week of disease onset.
Findings:
- Nine scans revealed increased isotope uptake, consistent with osteomyelitis.
- Twenty-nine scans were negative, yet four patients later showed radiological signs of osteomyelitis.
- A missed "cold" lesion (decreased uptake) was associated with progression to chronic osteomyelitis despite drainage.
Implications:
- Bone scanning is a valuable tool for early osteomyelitis diagnosis in pediatric patients.
- Negative bone scans do not exclude osteomyelitis; clinical correlation is essential.
- "Cold" lesions on bone scans may signify abscesses, necessitating prompt surgical intervention to prevent complications like sequestrum formation.
Abstract:
Thirty-nine bone scans were performed in children (1 week - 14 years of age), with symptoms and signs of acute osteomyelitis. All but two scintigrams were obtained within the first week of the disease. Nine scans showed locally increased isotope accumulation. The diagnosis of osteomyelitis was later confirmed by radiological examination or by positive cultures. Twenty-nine scans were reported negative. Nevertheless, four patients developed characteristic radiological signs of osteomyelitis. In one of these four cases a decreased uptake ("cold" lesion) in the scintigram was over-looked. In spite of surgical drainage the patient developed chronic osteomyelitis. It is concluded that bone scanning is a valuable adjunct in the early diagnosis of osteomyelitis. A negative scintigram, however, does not exclude this diagnosis. A "cold" lesion may indicate a high pressure abscess and a risk for sequestrum formation. Prompt surgical drainage is advocated when such lesions are encountered in the scintigram.