Ultrasonography: Can It Differentiate Between Vasoocclusive Crisis and Acute Osteomyelitis in Sickle Cell Disease?

Bone involvement in sickle cell disease

“…It has also the advantage of being rapid, non-invasive and fairly simple to target to the area(s) of maximum pain (Sidhu & Rich, 1999). The sensitivity of ultrasonography in diagnosing osteomyelitis in sickle cell disease has been reported to be as high as 74% (Rifai & Nyman, 1997;Sadat-Ali et al, 1998;William et al, 2000;Riebel et al, 2003). However, as with computer tomography (Stark et al, 1991), the main 'diagnostic' finding (subperiosteal fluid) is not specific and can also be present during vaso-occlusive crises, although greater fluid depths (>4 mm) are reported to be highly associated with a diagnosis of osteomyelitis (William et al, 2000).…”

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

“…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.…”

“…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.…”

Osteomyelitis: A manifestation of sickle cell anemia

“…The US shows the extraosseous pathology in acute cases and may also show periosteal elevation [28]. The US test exhibits 74% sensitivity in diagnosis osteomyelitis in SCA [28][29][30][31]. However, the main diagnostic finding, i.e., the presence of subperiosteal fluid, is non-specific and can also be present during VOC [28].…”

“…Ciprofloxacin is considered as a suitable alternative for treating Salmonella infection in older children. In the case of adults, who have been infected with other species, such as Staphylococcus empirical antibiotic treatment should be followed [30]. In confirmed cases of osteomyelitis, a six-week treatment plan needs to be followed.…”