A Prospective Study of Soft-Tissue Ultrasonography in Sickle Cell Disease Patients with Suspected Osteomyelitis

William, Ranjan; Hussein, Samir S.; Jeans, W. D.; Wali, Yasser; Lamki, Zakiya Al

doi:10.1053/crad.1999.0377

Cited by 42 publications

(24 citation statements)

References 14 publications

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“…Ultrasonography is a rapid noninvasive way of showing extra osseous pathology associated with OM; however it has only 74% sensitivity, and findings are nonspecific [264, 265]. Computer tomography may show subperiosteal fluid collections with deeper collections correlating more with presence of infection [266, 267]. The use of radio-labeled isotopes and tagged leukocyte scans is less frequent as false negatives and positives occur frequently.…”

Section: Muscular/skeletal/skin Complicationsmentioning

confidence: 99%

Beyond the Definitions of the Phenotypic Complications of Sickle Cell Disease: An Update on Management

Ballas

Kesen

Goldberg

et al. 2012

The Scientific World Journal

153

144

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The sickle hemoglobin is an abnormal hemoglobin due to point mutation (GAG → GTG) in exon 1 of the β globin gene resulting in the substitution of glutamic acid by valine at position 6 of the β globin polypeptide chain. Although the molecular lesion is a single-point mutation, the sickle gene is pleiotropic in nature causing multiple phenotypic expressions that constitute the various complications of sickle cell disease in general and sickle cell anemia in particular. The disease itself is chronic in nature but many of its complications are acute such as the recurrent acute painful crises (its hallmark), acute chest syndrome, and priapism. These complications vary considerably among patients, in the same patient with time, among countries and with age and sex. To date, there is no well-established consensus among providers on the management of the complications of sickle cell disease due in part to lack of evidence and in part to differences in the experience of providers. It is the aim of this paper to review available current approaches to manage the major complications of sickle cell disease. We hope that this will establish another preliminary forum among providers that may eventually lead the way to better outcomes.

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Section: Muscular/skeletal/skin Complicationsmentioning

confidence: 99%

Beyond the Definitions of the Phenotypic Complications of Sickle Cell Disease: An Update on Management

Ballas

Kesen

Goldberg

et al. 2012

The Scientific World Journal

153

144

View full text Add to dashboard Cite

show abstract

“…MRI scans are not always readily accessible; this may be due either to cost or availability. However ultrasound scans (USS) alone has previously been shown to be a useful investigation in diagnosing osteomyelitis in patients with SCD with sensitivity of 74% and a specificity of 63% [10], [11]. The aim of this study was to assess the additional benefit of CRP and WCC as a tool in aiding early diagnosis in children with SCD presenting acutely with bone pain, fever or swelling.…”

Section: Introductionmentioning

confidence: 99%

Dilemma in Differentiating between Acute Osteomyelitis and Bone Infarction in Children with Sickle Cell Disease: The Role of Ultrasound

et al. 2013

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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.

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“…Bone scans are of limited utility [5,8]. Some studies report high reliability of US for the differentiation of bone infarct versus osteomyelitis in children with SCD because of US findings of soft-tissue abnormalities and subperiosteal collection [6,12,13]. However in our US experience and based on the results of this MRI study, soft-tissue changes and subperiosteal fluid collection occur in both processes, so these cannot accurately distinguish between the two.…”

Section: Discussionmentioning

confidence: 79%

“…Computed tomography (CT), ultrasonography (US) and enhanced MRI do not reliably distinguish these two entities [9][10][11][12][13]. To our knowledge, only a single article, with a population age 2-37 years, has suggested the use of unenhanced fat-suppressed T1-weighed images for the differentiation of bone infarct and osteomyelitis in children with SCD; Jain et al [14] reported areas of high bone marrow signal intensity in patients with bone infarct and areas of low bone marrow signal intensity in acute osteomyelitis.…”

Section: Introductionmentioning

confidence: 99%

Utility of unenhanced fat-suppressed T1-weighted MRI in children with sickle cell disease — can it differentiate bone infarcts from acute osteomyelitis?

et al. 2015

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A Prospective Study of Soft-Tissue Ultrasonography in Sickle Cell Disease Patients with Suspected Osteomyelitis

Cited by 42 publications

References 14 publications

Beyond the Definitions of the Phenotypic Complications of Sickle Cell Disease: An Update on Management

Beyond the Definitions of the Phenotypic Complications of Sickle Cell Disease: An Update on Management

Dilemma in Differentiating between Acute Osteomyelitis and Bone Infarction in Children with Sickle Cell Disease: The Role of Ultrasound

Utility of unenhanced fat-suppressed T1-weighted MRI in children with sickle cell disease — can it differentiate bone infarcts from acute osteomyelitis?

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