PubMed · 539106
The source did not provide an abstract. Follow the original record for more information.
Explore connections, maps & timelines
R D'Silva. Pitfalls in general practice.. https://pubmed.ncbi.nlm.nih.gov/539106/
Cite the original work for its findings. Save a collection to share your selection of sources.
KEEP EXPLORING
The diagnosis of osteomyelitis remains a difficult diagnostic dilemma. In this article, which is particularly aimed at those whose practice does not include a large paediatric population, we review the pathophysiology of paediatric osteomyelitis and contrast it with the available imaging modalities. We examine the role of the radiologist as well as the usefulness of each modality. Secondly, we review the different clinical scenarios such as acute, subacute and chronic, as well as specific forms of osteomyelitis; the latter includes subacute chronic ostemyelitis, toxic synovitis, spondylodiscitis as well as the congenital inflammatory disorders such as rubella and syphylis. The most useful imaging findings to look for and their significance are assessed and we evaluate their usefulness in each case. Close cooperation between clinicians and imagers remains the key to early and adequate diagnosis of paediatric osteomyelitis.
Soft tissue infection may be acute or chronic and may be introduced by the haematogenous route, or by inoculation, including surgical infection, or spread from other areas. The spectrum of infecting organism differs in primary infection, in immunodeficiency or when foreign bodies, including prostheses, are present. Bacterial infections are usually more rapid than those due to fungi or atypical organisms. Inflammation usually begins as cellulitis, proceeding through necrosis to cavitation and abscess formation, sometimes complicated by haemorrhage. Imaging, apart from MRI in selected cases, is rarely helpful in the early stages, but early diagnosis of pyomyositis and necrotizing fasciitis is mandatory. When infection is established, US, CT and MRI all have individual value in diagnosis, including biopsy, and in directing therapy, including percutaneous or surgical drainage or debridement. Both MRI and CT are best suited to monitoring progress. Septic arthritis presents as rapidly progressive, destructive arthritis, and early diagnosis is essential to prevent long-term morbidity. Ultrasound offers the best method of detecting early joint effusion and synovial thickening, but aspiration is usually required for diagnosis. In more advanced stages CT is valuable for revealing destructive changes, and MRI for documenting intra-articular changes and detecting inflammation in surrounding bone.
Explore the source record for details and available documents.