SPECT/CT offers improved characterization of osseous pathology compared with planar imaging [59]. MRI is generally considered preferable in detection of early manifestations of osteomyelitis, as well as infection of the surrounding soft tissues, because of the rapid progression of the disease [53]. Osteomyelitis or Septic Arthritis-Child CT Area of Interest There is no relevant literature regarding the use of CT as the next imaging study in evaluation of osteomyelitis or septic arthritis in children under 5 years of age. Image-Guided Aspiration Area of Interest Primary differential considerations when a joint effusion is present in the absence of trauma are transient synovitis and septic arthritis. Although the most common locations of septic arthritis are the knee and hip joints, this can affect any joint [60]. Although most nontraumatic hip joint effusions are secondary to transient synovitis, early diagnosis of septic arthritis is extremely important in preventing complications, and US-guided hip aspiration is considered highly accurate for diagnosis [43,61]. In one study, 100% of children were confirmed to have septic hip arthritis via bedside joint aspiration and were able to avoid arthrotomy. However, it should be noted than US guidance for aspiration was only provided in one case, and the remainder were performed using anatomic landmarks without imaging guidance [62]. In the setting of confirmed transient synovitis, children who underwent US-guided joint aspiration experienced shorter duration of stay and shorter duration of a limp compared with those who did not undergo joint aspiration [61]. In patients with suspected or confirmed septic arthritis, femoral neck aspiration performed at the time of incision and drainage was noted to improve diagnosis of concurrent osteomyelitis compared with preoperative MRI alone [63].
Osteomyelitis or Septic Arthritis Child Excluding Axial Skeleton PCAs. SPECT/CT offers improved characterization of osseous pathology compared with planar imaging [59]. MRI is generally considered preferable in detection of early manifestations of osteomyelitis, as well as infection of the surrounding soft tissues, because of the rapid progression of the disease [53]. Osteomyelitis or Septic Arthritis-Child CT Area of Interest There is no relevant literature regarding the use of CT as the next imaging study in evaluation of osteomyelitis or septic arthritis in children under 5 years of age. Image-Guided Aspiration Area of Interest Primary differential considerations when a joint effusion is present in the absence of trauma are transient synovitis and septic arthritis. Although the most common locations of septic arthritis are the knee and hip joints, this can affect any joint [60]. Although most nontraumatic hip joint effusions are secondary to transient synovitis, early diagnosis of septic arthritis is extremely important in preventing complications, and US-guided hip aspiration is considered highly accurate for diagnosis [43,61]. In one study, 100% of children were confirmed to have septic hip arthritis via bedside joint aspiration and were able to avoid arthrotomy. However, it should be noted than US guidance for aspiration was only provided in one case, and the remainder were performed using anatomic landmarks without imaging guidance [62]. In the setting of confirmed transient synovitis, children who underwent US-guided joint aspiration experienced shorter duration of stay and shorter duration of a limp compared with those who did not undergo joint aspiration [61]. In patients with suspected or confirmed septic arthritis, femoral neck aspiration performed at the time of incision and drainage was noted to improve diagnosis of concurrent osteomyelitis compared with preoperative MRI alone [63].