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Dilemma in differentiating between acute osteomyelitis and bone infarction in children with sickle cell disease: the role of ultrasound.

Inusa BP, Oyewo A, Brokke F, Santhikumaran G, Jogeesvaran KH - PLoS ONE (2013)

Bottom Line: Mean C-reactive protein (CRP), and white cell count (WCC) were significantly higher in the OM.The 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.

View Article: PubMed Central - PubMed

Affiliation: Department of Paediatrics, Evelina Children's Hospital, Guy's and St. Thomas' National Health Service (NHS) Foundation Trust, London, United Kingdom. baba.inusa@gstt.nhs.uk

ABSTRACT

Background: Distinguishing 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.

Methods: We 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.

Results: In 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.

Conclusion: The 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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Related in: MedlinePlus

Lower limb USS I a 3-year-old patient with osteomyelitis.
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pone-0065001-g004: Lower limb USS I a 3-year-old patient with osteomyelitis.

Mentions: A total of forty one (41) SCD patients were included in the review with a discharge diagnosis of osteomyelitis.. The discharge diagnosis of osteomyelitis was based on positive radiological findings interpreted together with haematological investigations, blood cultures, and bone or joint aspirate. A positive USS finding for diagnosis of osteomyelitis was defined as presence of a significant periosteal elevation (>0.4 cm) in accordance with (10,11) as shown in Figures 4. All but four US images were review by HJ. The MRI scan (figure 5) and nuclear medicine bone scan was considered to be positive if it was reported by the consultant radiologist as showing changes consistent with osteomyelitis in line with Jain et al, 2008 (7).


Dilemma in differentiating between acute osteomyelitis and bone infarction in children with sickle cell disease: the role of ultrasound.

Inusa BP, Oyewo A, Brokke F, Santhikumaran G, Jogeesvaran KH - PLoS ONE (2013)

Lower limb USS I a 3-year-old patient with osteomyelitis.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3675051&req=5

pone-0065001-g004: Lower limb USS I a 3-year-old patient with osteomyelitis.
Mentions: A total of forty one (41) SCD patients were included in the review with a discharge diagnosis of osteomyelitis.. The discharge diagnosis of osteomyelitis was based on positive radiological findings interpreted together with haematological investigations, blood cultures, and bone or joint aspirate. A positive USS finding for diagnosis of osteomyelitis was defined as presence of a significant periosteal elevation (>0.4 cm) in accordance with (10,11) as shown in Figures 4. All but four US images were review by HJ. The MRI scan (figure 5) and nuclear medicine bone scan was considered to be positive if it was reported by the consultant radiologist as showing changes consistent with osteomyelitis in line with Jain et al, 2008 (7).

Bottom Line: Mean C-reactive protein (CRP), and white cell count (WCC) were significantly higher in the OM.The 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.

View Article: PubMed Central - PubMed

Affiliation: Department of Paediatrics, Evelina Children's Hospital, Guy's and St. Thomas' National Health Service (NHS) Foundation Trust, London, United Kingdom. baba.inusa@gstt.nhs.uk

ABSTRACT

Background: Distinguishing 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.

Methods: We 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.

Results: In 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.

Conclusion: The 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.

Show MeSH
Related in: MedlinePlus