Acute Osteomyelitis in Pediatrics

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Acute Osteomyelitis in Pediatrics

• Jan Stauss
• S. Ted Treves, MD
• July 25, 2002

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Patient Information

• An otherwise Healthy 11year-old boy with
  increasing right knee pain and persistent fever
  for eight to nine days presents to the emergency
  room. Plain films of the right knee were negative.

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Imaging Information

• A three phase bone scan was performed. The scan,
  at the region of the knees demonstrated increased
  blood flow to the region of the upper tibia

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The tissue phase image reveals increased tracer
concentration in the same region.
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• A whole body scan confirmed the abnormal tracer
  uptake in the right proximal tibia, just below
  the childs epiphyseal growth plate
• But no skeletal abnormalities were detected on
  the bone scans

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Diagnosis

• Differential dianosis
• Osteomyelitis
• Cellulitis overlying bone
• Diagnosis
• Osteomyelitis of the right proximal tibia

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Other studies that can be done

• The most sensitivebut nonspecific laboratory
  study to determine is the erythrocyte
  sedimentation rate. The white blood cell count is
  surprisingly normal in the majority of cases.
• MRI is also helpful, when acute osteomyelitis
  does not respond to antibiotic therapy and
  localized abscess is suspected
• When scintigraphy is normal but symptoms persist,
  the study should be repeated after 2 to 3 day
• The three phase bone scan typically shows
  increased tracer delivery and localization on
  radionuclide angiographic and tissue-phase images
  and increased uptake on skeletal-phase images

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Brain Scan/Death

• Gabriel Soudry, MD J Stevan Nagel, MD June 16,
  1994

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Patient History

• A 47-year-old man was working on his boat when he
  fell to the ground unconscious. He was taken to a
  local emergency ward where a head CT showed a
  large brainstem hemorrhage. The next day a brain
  death evaluation was begun and a brain scan was
  ordered

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Imaging Information

• On Tc-99m HMPAO brain scintigraphy, the initial
  anterior flow study and subsequent planar views
  in the anterior and lateral projections
  demonstrate no appreciable intracerebral blood
  flow in either the internal carotid or posterior
  cerebral circulations

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Diagnosis

• Brain death
• Brain death is characterized by absent cerebral
  blood flow and global cerebral infarction. The
  brain scan can be used to confirm the absence of
  cerebral perfusion in suspected brain death. The
  study an be performed with intravenous bolus
  injection of Tc-99m HMPAO. Flow images are
  obtained in the anterior projection. Delayed
  images follow 5 to 10 minutes after the
  injection. Anterior and both lateral planar views
  are usually obtained. The diagnosis of brain
  death can be made only if intracranial activity
  is absent