Primary subacute haematogenous osteomyelitis in children

Abstract

Between 1990 and 1998 we saw 21 children with primary subacute haematogenous osteomyelitis. Pain, swelling and a limp had been present for two to 12 weeks with little functional impairment. Laboratory tests were non-contributory. The lesions were classified radiologically into metaphyseal, diaphyseal, epiphyseal and vertebral. There were 24 sites involved, with most (20) being in the tibia; 17 lesions were in the diaphysis, five in the metaphysis and two in the epiphysis. The diagnosis was confirmed histologically in all cases. Staphylococcus aureus was cultured in six patients. Healing occurred in all patients after treatment with antibiotics for six weeks and radiological improvement was seen after three to six months. Subacute osteomyelitis develops as a result of increased host resistance and decreased bacterial virulence. The radiological features can mimic various benign or malignant bone tumours and non-pyogenic infections. Histological confirmation is necessary to avoid a delay in diagnosis.

Rare presentation of Brodie's abscess in the acromion process and the value of the penumbra sign

“…The abscess probably developed before epiphysial closure and is most likely of haematogenous origin, since the first punctured fluid contained S. aureus and no wound or other port of entrance was discovered. Rasool4 emphasised the importance in distinguishing the true primary haematogenous form of subacute osteomyelitis, which occurs mainly in children, from types where previous (inadequate) antibiotic treatment might have played a role in the development of some sort of equilibrium between pathogen virulence and host immune response. Although the first presentation fits the description of a true primary haematogenous Brodie's abscess, the recent presentation can also be interpreted as the result of inadequate treatment or as a direct (re)infection caused by contamination during the previous surgery.…”

“…The patient history was suggestive of an infectious problem, which was strongly supported by a positive penumbra sign. When the diagnosis is unclear and conventional imaging techniques fail to offer a conclusive diagnosis, (hybrid) nuclear imaging techniques such as single-photon emission CT/CT, positron emission tomography/CT and technetium bone scans can be of value, especially for unconventional presentations or to identify multiple lesions 4 12 30…”

Primary subacute epiphyseal and metaepiphyseal osteomyelitis in children

“…Only 44 cases have been reported. 4,7,[9][10][11][12][13][14][15][16][17][18][19][20][21][22] To our knowledge, case 1 represents the first report of the use of MRI in primary subacute osteomyelitis confined to the epiphysis. It showed massive contrast enhancement in the distal femoral epiphysis and evidence of perforation of the lateral condyle (Figs 1b and 1c), which was confirmed at operation.…”

“…[1][2][3][4] The diagnosis is often delayed because of slow onset, intermittent pain, absence of general malaise and subtle radiological changes. [4][5][6][7] The advent of MRI has led to earlier detection and more precise localisation of the infection. 8 Involvement of the epiphysis is extremely rare and we believe that this is the first time that MR scans of primary subacute epiphyseal osteomyelitis have been reported.…”

“…8 Involvement of the epiphysis is extremely rare and we believe that this is the first time that MR scans of primary subacute epiphyseal osteomyelitis have been reported. 4,7,[9][10][11][12][13][14][15][16][17][18][19][20][21][22] Methods For MRI we used 0.5 Tesla scanners (Gyroscan T5 II and Gyroscan ACS-NT; Philips Medical Systems, Eindhoven, W The Netherlands) with knee coils for two patients (cases 1 and 3) and a surface coil for one patient (case 2). Spin-echo (SE) images with T1-weighting (TR 406-420/TE [15][16][17][18][19][20] were obtained before and after the intravenous injection of contrast medium (gadolinium-DTPA, 0.1 mmol/kg Magnevist; Schering, Berlin, Germany) in all patients.…”