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Pediatrics
Diagnosis
Musculoskeletal
Infection and Inflammatory Disorders
Osteomyelitis
Osteomyelitis
A. Carlson Merrow, Jr., MD, FAAP
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KEY FACTS

  • Imaging

    • Top Differential Diagnoses

      • Pathology

        • Clinical Issues

          TERMINOLOGY

          • Definitions

            • Osteomyelitis: Bone infection, most commonly bacterial
            • Osteoarticular infection: Osteomyelitis &/or septic arthritis

          IMAGING

          • General Features

            • Radiographic Findings

              • CT Findings

                • Ultrasonographic Findings

                  • MR Findings

                    • Nuclear Medicine Findings

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            CLINICAL ISSUES

                            • Presentation

                              • Demographics

                                • Natural History & Prognosis

                                  • Treatment

                                    DIAGNOSTIC CHECKLIST

                                    • Consider

                                      • Image Interpretation Pearls

                                        Selected References

                                        1. Griswold BG et al: The Introduction of a preoperative MRI protocol significantly reduces unplanned return to the operating room in the treatment of pediatric osteoarticular infections. J Pediatr Orthop. 40(2):97-102, 2020
                                        2. Shahid M et al: Sonography of musculoskeletal infection in children. Ultrasound. 28(2):103-17, 2020
                                        3. Weisman JK et al: Characteristics and outcomes of osteomyelitis in children with sickle cell disease: a 10-year single-center experience. Pediatr Blood Cancer. 67(5):e28225, 2020
                                        4. Wyers MR et al: Physeal separation in pediatric osteomyelitis. Pediatr Radiol. 49(9):1229-33, 2019
                                        5. Erdem G et al: Clinical and radiologic manifestations of bone infection in children with cat scratch disease. J Pediatr. 201:274-80.e12, 2018
                                        6. Greer MC: Whole-body magnetic resonance imaging: techniques and non-oncologic indications. Pediatr Radiol. 48(9):1348-63, 2018
                                        7. Manz N et al: Evaluation of the current use of imaging modalities and pathogen detection in children with acute osteomyelitis and septic arthritis. Eur J Pediatr. 177(7):1071-80, 2018
                                        8. Mignemi ME et al: A novel classification system based on dissemination of musculoskeletal infection is predictive of hospital outcomes. J Pediatr Orthop. 38(5):279-86, 2018
                                        9. Ernat J et al: Osteomyelitis is commonly associated with septic arthritis of the shoulder in children. J Pediatr Orthop. 37(8):547-52, 2017
                                        10. Jaramillo D et al: Hematogenous osteomyelitis in infants and children: imaging of a changing disease. Radiology. 283(3):629-43, 2017
                                        11. Al-Qwbani M et al: Kingella kingae-associated pediatric osteoarticular infections: an overview of 566 reported cases. Clin Pediatr (Phila). 55(14):1328-37, 2016
                                        12. Calvo C et al: Epidemiology and management of acute, uncomplicated septic arthritis and osteomyelitis: Spanish multicenter study. Pediatr Infect Dis J. 35(12):1288-93, 2016
                                        13. Chan BY et al: MR Imaging of pediatric bone marrow. Radiographics. 36(6):1911-30, 2016
                                        14. Davis JT et al: Pediatric whole-body MRI: a review of current imaging techniques and clinical applications. J Magn Reson Imaging. 44(4):783-93, 2016
                                        15. Rosenfeld S et al: Predicting the presence of adjacent infections in septic arthritis in children. J Pediatr Orthop. 36(1):70-4, 2016
                                        16. Delgado J et al: Utility of unenhanced fat-suppressed T1-weighted MRI in children with sickle cell disease -- can it differentiate bone infarcts from acute osteomyelitis? Pediatr Radiol. 45(13):1981-7, 2015
                                        17. Ilharreborde B: Sequelae of pediatric osteoarticular infection. Orthop Traumatol Surg Res. 101(1 Suppl):S129-37, 2015
                                        18. K Schallert E et al: Metaphyseal osteomyelitis in children: how often does MRI-documented joint effusion or epiphyseal extension of edema indicate coexisting septic arthritis? Pediatr Radiol. 45(8):1174-81, 2015
                                        19. Monsalve J et al: Septic arthritis in children: frequency of coexisting unsuspected osteomyelitis and implications on imaging work-up and management. AJR Am J Roentgenol. 204(6):1289-95, 2015
                                        20. Dodwell ER: Osteomyelitis and septic arthritis in children: current concepts. Curr Opin Pediatr. 25(1):58-63, 2013
                                        21. Falip C et al: Chronic recurrent multifocal osteomyelitis (CRMO): a longitudinal case series review. Pediatr Radiol. 43(3):355-75, 2013
                                        22. Browne LP et al: Community-acquired staphylococcal musculoskeletal infection in infants and young children: necessity of contrast-enhanced MRI for the diagnosis of growth cartilage involvement. AJR Am J Roentgenol. 198(1):194-9, 2012
                                        23. Kanavaki A et al: Can early MRI distinguish between Kingella kingae and Gram-positive cocci in osteoarticular infections in young children? Pediatr Radiol. 42(1):57-62, 2012
                                        24. Jaramillo D: Infection: musculoskeletal. Pediatr Radiol. 41 Suppl 1:S127-34, 2011
                                        25. Kan JH et al: Clinical impact of gadolinium in the MRI diagnosis of musculoskeletal infection in children. Pediatr Radiol. 40(7):1197-205, 2010
                                        26. Hawkshead JJ 3rd et al: Comparative severity of pediatric osteomyelitis attributable to methicillin-resistant versus methicillin-sensitive Staphylococcus aureus. J Pediatr Orthop. 29(1):85-90, 2009
                                        27. Ranson M: Imaging of pediatric musculoskeletal infection. Semin Musculoskelet Radiol. 13(3):277-99, 2009
                                        28. McGuinness B et al: The "penumbra sign" on T1-weighted MRI for differentiating musculoskeletal infection from tumour. Skeletal Radiol. 36(5):417-21, 2007
                                        29. Davies AM et al: Intramedullary and extramedullary fat globules on magnetic resonance imaging as a diagnostic sign for osteomyelitis. Eur Radiol. 15(10):2194-9, 2005
                                        Related Anatomy
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                                        Related Differential Diagnoses
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                                        References
                                        Tables

                                        Tables

                                        KEY FACTS

                                        • Imaging

                                          • Top Differential Diagnoses

                                            • Pathology

                                              • Clinical Issues

                                                TERMINOLOGY

                                                • Definitions

                                                  • Osteomyelitis: Bone infection, most commonly bacterial
                                                  • Osteoarticular infection: Osteomyelitis &/or septic arthritis

                                                IMAGING

                                                • General Features

                                                  • Radiographic Findings

                                                    • CT Findings

                                                      • Ultrasonographic Findings

                                                        • MR Findings

                                                          • Nuclear Medicine Findings

                                                            • Imaging Recommendations

                                                              DIFFERENTIAL DIAGNOSIS

                                                                PATHOLOGY

                                                                • General Features

                                                                  CLINICAL ISSUES

                                                                  • Presentation

                                                                    • Demographics

                                                                      • Natural History & Prognosis

                                                                        • Treatment

                                                                          DIAGNOSTIC CHECKLIST

                                                                          • Consider

                                                                            • Image Interpretation Pearls

                                                                              Selected References

                                                                              1. Griswold BG et al: The Introduction of a preoperative MRI protocol significantly reduces unplanned return to the operating room in the treatment of pediatric osteoarticular infections. J Pediatr Orthop. 40(2):97-102, 2020
                                                                              2. Shahid M et al: Sonography of musculoskeletal infection in children. Ultrasound. 28(2):103-17, 2020
                                                                              3. Weisman JK et al: Characteristics and outcomes of osteomyelitis in children with sickle cell disease: a 10-year single-center experience. Pediatr Blood Cancer. 67(5):e28225, 2020
                                                                              4. Wyers MR et al: Physeal separation in pediatric osteomyelitis. Pediatr Radiol. 49(9):1229-33, 2019
                                                                              5. Erdem G et al: Clinical and radiologic manifestations of bone infection in children with cat scratch disease. J Pediatr. 201:274-80.e12, 2018
                                                                              6. Greer MC: Whole-body magnetic resonance imaging: techniques and non-oncologic indications. Pediatr Radiol. 48(9):1348-63, 2018
                                                                              7. Manz N et al: Evaluation of the current use of imaging modalities and pathogen detection in children with acute osteomyelitis and septic arthritis. Eur J Pediatr. 177(7):1071-80, 2018
                                                                              8. Mignemi ME et al: A novel classification system based on dissemination of musculoskeletal infection is predictive of hospital outcomes. J Pediatr Orthop. 38(5):279-86, 2018
                                                                              9. Ernat J et al: Osteomyelitis is commonly associated with septic arthritis of the shoulder in children. J Pediatr Orthop. 37(8):547-52, 2017
                                                                              10. Jaramillo D et al: Hematogenous osteomyelitis in infants and children: imaging of a changing disease. Radiology. 283(3):629-43, 2017
                                                                              11. Al-Qwbani M et al: Kingella kingae-associated pediatric osteoarticular infections: an overview of 566 reported cases. Clin Pediatr (Phila). 55(14):1328-37, 2016
                                                                              12. Calvo C et al: Epidemiology and management of acute, uncomplicated septic arthritis and osteomyelitis: Spanish multicenter study. Pediatr Infect Dis J. 35(12):1288-93, 2016
                                                                              13. Chan BY et al: MR Imaging of pediatric bone marrow. Radiographics. 36(6):1911-30, 2016
                                                                              14. Davis JT et al: Pediatric whole-body MRI: a review of current imaging techniques and clinical applications. J Magn Reson Imaging. 44(4):783-93, 2016
                                                                              15. Rosenfeld S et al: Predicting the presence of adjacent infections in septic arthritis in children. J Pediatr Orthop. 36(1):70-4, 2016
                                                                              16. Delgado J et al: Utility of unenhanced fat-suppressed T1-weighted MRI in children with sickle cell disease -- can it differentiate bone infarcts from acute osteomyelitis? Pediatr Radiol. 45(13):1981-7, 2015
                                                                              17. Ilharreborde B: Sequelae of pediatric osteoarticular infection. Orthop Traumatol Surg Res. 101(1 Suppl):S129-37, 2015
                                                                              18. K Schallert E et al: Metaphyseal osteomyelitis in children: how often does MRI-documented joint effusion or epiphyseal extension of edema indicate coexisting septic arthritis? Pediatr Radiol. 45(8):1174-81, 2015
                                                                              19. Monsalve J et al: Septic arthritis in children: frequency of coexisting unsuspected osteomyelitis and implications on imaging work-up and management. AJR Am J Roentgenol. 204(6):1289-95, 2015
                                                                              20. Dodwell ER: Osteomyelitis and septic arthritis in children: current concepts. Curr Opin Pediatr. 25(1):58-63, 2013
                                                                              21. Falip C et al: Chronic recurrent multifocal osteomyelitis (CRMO): a longitudinal case series review. Pediatr Radiol. 43(3):355-75, 2013
                                                                              22. Browne LP et al: Community-acquired staphylococcal musculoskeletal infection in infants and young children: necessity of contrast-enhanced MRI for the diagnosis of growth cartilage involvement. AJR Am J Roentgenol. 198(1):194-9, 2012
                                                                              23. Kanavaki A et al: Can early MRI distinguish between Kingella kingae and Gram-positive cocci in osteoarticular infections in young children? Pediatr Radiol. 42(1):57-62, 2012
                                                                              24. Jaramillo D: Infection: musculoskeletal. Pediatr Radiol. 41 Suppl 1:S127-34, 2011
                                                                              25. Kan JH et al: Clinical impact of gadolinium in the MRI diagnosis of musculoskeletal infection in children. Pediatr Radiol. 40(7):1197-205, 2010
                                                                              26. Hawkshead JJ 3rd et al: Comparative severity of pediatric osteomyelitis attributable to methicillin-resistant versus methicillin-sensitive Staphylococcus aureus. J Pediatr Orthop. 29(1):85-90, 2009
                                                                              27. Ranson M: Imaging of pediatric musculoskeletal infection. Semin Musculoskelet Radiol. 13(3):277-99, 2009
                                                                              28. McGuinness B et al: The "penumbra sign" on T1-weighted MRI for differentiating musculoskeletal infection from tumour. Skeletal Radiol. 36(5):417-21, 2007
                                                                              29. Davies AM et al: Intramedullary and extramedullary fat globules on magnetic resonance imaging as a diagnostic sign for osteomyelitis. Eur Radiol. 15(10):2194-9, 2005