74 - I feel it in my bones: Osteomyelitis

Abstract

Osteomyelitis can be difficult to diagnose, especially early in the course of the illness. History, physical examination, and laboratory investigations are important in making the diagnosis of osteomyelitis, but imaging plays a crucial role in locating the infection and, if present, associated abscesses. Plain radiography is a first-line imaging modality in pediatric patients with musculoskeletal complaints but may not demonstrate abnormalities in the initial stages of osteomyelitis, although cortical changes may be noted approximately 10–14 days after the onset of infection. Three-phase bone scanning with technetium-99 traditionally has been utilized to detect osteomyelitis, but this modality can have difficulty distinguishing infection from other causes of increased uptake, such as neoplasm. Magnetic resonance imaging is the preferred modality of choice to detect osteomyelitis and, if present, associated abscess. While the need for gadolinium at the time of presentation is somewhat controversial, there are clinical situations where it is indicated.