IngentaConnect Occult epiphyseal bone abscess: Lessons for the unwary

Authors: Solomon, Michael¹; Stening, Michael¹; Macdessi, Samuel¹; Shearman, Christine²; Pereira, John²; Hiew, Chee Chung²; Van der Wall, Hans³

Source: Australasian Radiology, Volume 47, Number 2, June 2003 , pp. 181-183(3)

Publisher: Blackwell Publishing

Abstract:

Summary

Two male children presented with increasing pain in the right knee and constitutional symptoms. Biochemical markers of inflammation were elevated. Plain radiography was reported as normal and bone scintigraphy was consistent with synovitis of the right knee in the first case. The second child underwent aspiration of the knee with drainage of turbid fluid 1 week after antibiotics. Slow response to therapy led to MRI and CT scanning in the second child, revealing an epiphyseal abscess. Review of the scintigraphic studies in the first child raised the possibility of osteomyelitis of the distal right femur. Further imaging was undertaken with MRI and CT scanning confirming an epiphyseal bone abscess. Failure of diagnosis of an epiphyseal bone abscess by combined plain radiography and scintigraphy has not previously been reported and provides a number of valuable lessons.

Keywords: bone abscess; computed tomography scan; epiphyseal osteomyelitis; magnetic resonance imaging; scintigraphy

Document Type: Research article

DOI: 10.1046/j.0004-8461.2003.01148.x

Affiliations: 1: Department of Pediatric Orthopedics, Sydney Children's Hospital, 2: Department of Radiology, Prince of Wales Hospital, and 3: Department of Nuclear Medicine, Concord Hospital, Sydney, Australia

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