Book contents
- Frontmatter
- Contents
- Acknowledgements
- Preface
- List of abbreviations
- Section I Musculoskeletal radiology
- Achilles tendonopathy/rupture
- Aneurysmal bone cysts
- Ankylosing spondylitis
- Avascular necrosis – osteonecrosis
- Femoral-head osteonecrosis
- Kienböck's disease
- Back pain – including spondylolisthesis/spondylolysis
- Bone cysts
- Bone infarcts (medullary)
- Charcot joint (neuropathic joint)
- Complex regional-pain syndrome
- Crystal deposition disorders
- Developmental dysplasia of the hip (DDH)
- Discitis and vertebral osteomyelitis
- Disc prolapse – PID – ‘slipped discs’ and sciatica
- Diffuse idiopathic skeletal hyperostosis (DISH)
- Dysplasia – developmental disorders
- Enthesopathy
- Gout
- Haemophilia
- Hyperparathyroidism
- Hypertrophic pulmonary osteoarthropathy
- Irritable hip/transient synovitis
- Juvenile idiopathic arthritis
- Langerhans-cell histiocytosis
- Lymphoma of bone
- Metastases to bone
- Multiple myeloma
- Myositis ossificans
- Non-accidental injury
- Osteoarthrosis – osteoarthritis
- Osteochondroses
- Osteomyelitis (acute)
- Osteoporosis
- Paget's disease
- Perthes disease
- Pigmented villonodular synovitis (PVNS)
- Psoriatic arthropathy
- Renal osteodystrophy (including osteomalacia)
- Rheumatoid arthritis
- Rickets
- Rotator-cuff disease
- Scoliosis
- Scheuermann's disease
- Septic arthritis – native and prosthetic joints
- Sickle-cell anaemia
- Slipped upper femoral epiphysis (SUFE)
- Tendinopathy – tendonitis
- Tuberculosis
- Tumours of bone (benign and malignant)
- Section II Trauma radiology
Osteomyelitis (acute)
from Section I - Musculoskeletal radiology
Published online by Cambridge University Press: 22 August 2009
- Frontmatter
- Contents
- Acknowledgements
- Preface
- List of abbreviations
- Section I Musculoskeletal radiology
- Achilles tendonopathy/rupture
- Aneurysmal bone cysts
- Ankylosing spondylitis
- Avascular necrosis – osteonecrosis
- Femoral-head osteonecrosis
- Kienböck's disease
- Back pain – including spondylolisthesis/spondylolysis
- Bone cysts
- Bone infarcts (medullary)
- Charcot joint (neuropathic joint)
- Complex regional-pain syndrome
- Crystal deposition disorders
- Developmental dysplasia of the hip (DDH)
- Discitis and vertebral osteomyelitis
- Disc prolapse – PID – ‘slipped discs’ and sciatica
- Diffuse idiopathic skeletal hyperostosis (DISH)
- Dysplasia – developmental disorders
- Enthesopathy
- Gout
- Haemophilia
- Hyperparathyroidism
- Hypertrophic pulmonary osteoarthropathy
- Irritable hip/transient synovitis
- Juvenile idiopathic arthritis
- Langerhans-cell histiocytosis
- Lymphoma of bone
- Metastases to bone
- Multiple myeloma
- Myositis ossificans
- Non-accidental injury
- Osteoarthrosis – osteoarthritis
- Osteochondroses
- Osteomyelitis (acute)
- Osteoporosis
- Paget's disease
- Perthes disease
- Pigmented villonodular synovitis (PVNS)
- Psoriatic arthropathy
- Renal osteodystrophy (including osteomalacia)
- Rheumatoid arthritis
- Rickets
- Rotator-cuff disease
- Scoliosis
- Scheuermann's disease
- Septic arthritis – native and prosthetic joints
- Sickle-cell anaemia
- Slipped upper femoral epiphysis (SUFE)
- Tendinopathy – tendonitis
- Tuberculosis
- Tumours of bone (benign and malignant)
- Section II Trauma radiology
Summary
Characteristics
Majority of primary osteomyelitis occurs in children. Usually occurs in adults secondary to debilitation or immune compromise (diabetes, drugs, disease).
Organism seeding is usually haematogenous or direct implantation from trauma (accidental or iatrogenic).
Causal organisms include Staphylococcus aureus, Group B Streptococcus and enteric species. In drug addicts Pseudomonas is common. Salmonella infection is associated with sickle-cell disease.
The metaphysis is the commonest site in children (e.g. proximal femur). In adults the spine is commonly affected. The lower extremities of diabetic patients are particularly at risk.
Pathological sequence usually follows inflammation, suppuration, necrosis, new bone formation ending with resolution.
Clinical features
Characteristically the patient is feverish and complains of severe pain associated with malaise. Local erythema, oedema and warmth tend to be later signs. In adults beware new-onset back pain associated with systemic upset.
Lymphadenopathy is usually present but non-specific.
Infants may simply present with failure to thrive with only a mild constitutional upset.
In the elderly and immuno-deficient patient, systemic features can again be mild. Take a full history – even an uncomplicated catheter change may be causative.
Radiological features
Initial plain films are often normal.
In the early stages look for distortion of fat planes signifying soft tissue swelling or adjacent fluid accumulation. Lucency may be visible after 5–7 days.
After approximately 10–14 days, bony necrosis and periosteal reaction become evident.
MRI – more sensitive in the early stages. Bone marrow is hypointense on T1WI + hyperintense on T2WI.
Nuclear medicine – high sensitivity with gallium or diphosphonate bone scans.
Management
Traditional management involves general supportive therapy for pain and dehydration.
Exclude septic arthritis in children with a reactive effusion.
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- A-Z of Musculoskeletal and Trauma Radiology , pp. 102 - 104Publisher: Cambridge University PressPrint publication year: 2008