Abstract
BackgroundDistinguishing between acute presentations of osteomyelitis (OM) and vaso-occlusive crisis (VOC) bone infarction in children with sickle cell disease (SCD) remains challenging for clinicians, particularly in culture-negative cases. We examined the combined role of ultrasound scan (USS), C - reactive protein and White blood counts (WCC) in aiding early diagnosis in children with SCD presenting acutely with non-specific symptoms such as bone pain, fever or swelling which are common in acute osteomyelitis or VOC.MethodsWe reviewed the records of all children with SCD who were discharged from our department from October 2003 to December 2010 with a diagnosis of osteomyelitis based on clinical features and the results of radiological and laboratory investigations. A case control group with VOC who were investigated for OM were identified over the same period.ResultsIn the osteomyelitis group, USS finding of periosteal elevation and/or fluid collection was reported in 76% cases with the first scan (day 0–6). Overall 84% were diagnosed with USS (initial +repeat). 16% had negative USS. With VOC group, USS showed no evidence of fluid collection in 53/58 admissions (91%), none of the repeated USS showed any fluid collection. Mean C-reactive protein (CRP), and white cell count (WCC) were significantly higher in the OM.ConclusionThe use of Ultrasound in combination with CRP and WCC is a reliable, cost-effective diagnostic tool for differentiating osteomyelitis from VOC bone infarction in SCD. A repeat ultrasound and/or magnetic resonance imaging (MRI) scan may be is necessary to confirm the diagnosis.
Highlights
Sickle Cell Disease (SCD) is a clinically significant haemoglobinopathy with increasing incidence in developed countries
The underlying pathology is the obstruction of the microvasculature by sickled red blood cells, resulting in chronic tissue ischaemia and tissue infarction; this may present as pain and/or swelling referred to as vaso-occlusive crisis (VOC)
Background demographic data including the symptoms at presentation and duration of these symptoms in osteomyelitis and vaso-occlusive crisis cohorts are illustrated in Tables 1, 2, 3 below
Summary
Sickle Cell Disease (SCD) is a clinically significant haemoglobinopathy with increasing incidence in developed countries. The underlying pathology is the obstruction of the microvasculature by sickled red blood cells, resulting in chronic tissue ischaemia and tissue infarction; this may present as pain and/or swelling referred to as vaso-occlusive crisis (VOC). Vaso-occlusive events are the most common acute clinical presentation of SCD in children [2]. Distinguishing between acute presentations of osteomyelitis (OM) and vaso-occlusive crisis (VOC) bone infarction in children with sickle cell disease (SCD) remains challenging for clinicians, in culture-negative cases. We examined the combined role of ultrasound scan (USS), C - reactive protein and White blood counts (WCC) in aiding early diagnosis in children with SCD presenting acutely with non-specific symptoms such as bone pain, fever or swelling which are common in acute osteomyelitis or VOC
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