Hematogenous Osteomyelitis in Infants and Children: Imaging of a Changing Disease

Abstract

In children, hematogenous osteomyelitis is an infection that primarily affects the most vascularized regions of the growing skeleton. The disease has increased in frequency, virulence, and degree of soft-tissue involvement. The change in clinical manifestations and management over the past 2 decades should be reflected in the current imaging approach to the disease. Imaging of infection must depict the location of a single focus or of multiple foci of involvement and the presence of drainable collections. This review provides an overview of the imaging implications directed by the changing epidemiology, the newer insights of anatomy and pathophysiology, the imaging characteristics with emphasis on specific locations and disease complications, and the differential diagnosis considerations. In addition, basic imaging guidelines for appropriate extent of area to image based on patient age are provided. RSNA, 2017.

Vertebral osteomyelitis in an adolescent girl

“…An MRI is considered the imaging modality of choice. 5 The MRI findings in Figure 2 are consistent with vertebral osteomyelitis of T11 and T12 and intervertebral discitis (i.e. spondylodiscitis).…”

“…Bartonella henselae infection should be in the differential diagnosis in patients with cat exposure, and mycobacterial infection should be considered in endemic areas. [1][2][3][4][5]7 WBCs are usually mildly elevated or normal, but inflammatory markers are usually elevated similar to this case. CRP and ESR are helpful in monitoring the response to appropriate treatment.…”

“…Bartonella henselae infection should be in the differential diagnosis in patients with cat exposure, and mycobacterial infection should be considered in endemic areas. 1 – 5 , 7 …”

“…Surgery is indicated in certain cases such as failure to respond to antibiotic treatment, abscess formation, and the development of neurological complications. 3,5…”

“…Delays in diagnosis and treatment can result in the spreading of the infection to the spinal canal and devastating neurological complications. 3 , 5 Treatment usually includes 6–8 weeks of antibiotics. 3 , 6 The most common organism is Staphylococcus aureus , including methicillin-resistant Staphylococcus aureus (MRSA).…”