Among patients who did not have osteomyelitis, 20% had contralateral abnormalities; most common diagnoses included stress reaction, soft-tissue edema, myositis, sterile joint effusion, and leukemia. Radiography Area of Interest Features of acute osteomyelitis on radiographs include periosteal reaction, a well-circumscribed focal bone lucency, and frank bone destruction. Radiographs are not sensitive in assessment of early osteomyelitis because bone destruction does not typically occur until 7 to 10 days into the disease course, and radiographs are normal until >30% osseous matrix destruction has occurred [24,40]. Radiographs, however, do have initial utility in all populations in excluding other entities that may mimic acute osteomyelitis, such as fracture or neoplasm and can be used to direct subsequent imaging evaluation [3,25,31,40]. A particularly challenging subset of patients to Osteomyelitis or Septic Arthritis-Child evaluate is those with sickle cell disease. One study found that 63% of patients with known hand or wrist osteomyelitis and underlying sickle cell disease had lytic radiographic changes or periosteal reaction, compared with 23% of patients without sickle cell disease, with the greater frequency in the sickle cell population attributed to either marrow infarction or osteomyelitis as the underlying cause for radiographic changes [41]. Radiographs are highly variable in identifying hip joint effusions, with sensitivity ranging from 20% to 73% [40,42,43]. Radiographs are also variable for identifying fluid in joints other than the hip. US Area of Interest Ultrasonography (US) is a highly sensitive method of diagnosing joint effusions, with the bulk of literature addressing the hip joint. US can reportedly detect hip effusions as small as 1 mL [44].
Osteomyelitis or Septic Arthritis Child Excluding Axial Skeleton PCAs. Among patients who did not have osteomyelitis, 20% had contralateral abnormalities; most common diagnoses included stress reaction, soft-tissue edema, myositis, sterile joint effusion, and leukemia. Radiography Area of Interest Features of acute osteomyelitis on radiographs include periosteal reaction, a well-circumscribed focal bone lucency, and frank bone destruction. Radiographs are not sensitive in assessment of early osteomyelitis because bone destruction does not typically occur until 7 to 10 days into the disease course, and radiographs are normal until >30% osseous matrix destruction has occurred [24,40]. Radiographs, however, do have initial utility in all populations in excluding other entities that may mimic acute osteomyelitis, such as fracture or neoplasm and can be used to direct subsequent imaging evaluation [3,25,31,40]. A particularly challenging subset of patients to Osteomyelitis or Septic Arthritis-Child evaluate is those with sickle cell disease. One study found that 63% of patients with known hand or wrist osteomyelitis and underlying sickle cell disease had lytic radiographic changes or periosteal reaction, compared with 23% of patients without sickle cell disease, with the greater frequency in the sickle cell population attributed to either marrow infarction or osteomyelitis as the underlying cause for radiographic changes [41]. Radiographs are highly variable in identifying hip joint effusions, with sensitivity ranging from 20% to 73% [40,42,43]. Radiographs are also variable for identifying fluid in joints other than the hip. US Area of Interest Ultrasonography (US) is a highly sensitive method of diagnosing joint effusions, with the bulk of literature addressing the hip joint. US can reportedly detect hip effusions as small as 1 mL [44].