Evidence-Based Emergency Imaging for Acute Musculoskeletal Infections in Adults and Children: Osteomyelitis, Septic Arthritis, and Soft Tissue Infection

Chapter
Part of the Evidence-Based Imaging book series (Evidence-Based Imag.)

Abstract

Acute musculoskeletal infections may pose diagnostic challenges in the emergency department. Presentation and imaging findings depend on age, underlying disease, and pathogen. Acute hematogenous osteomyelitis is most common in young children. There are unique considerations in adults with type II diabetes mellitus with pedal osteomyelitis and in children with sickle cell disease. MRI (complementary with radiography) is the imaging modality of choice for diagnosis of osteomyelitis and evaluating for complications. Acute septic arthritis is a medical urgency, and prompt diagnosis with ultrasound or MRI is crucial to prevent irreversible joint destruction. Soft tissue infections are common and seldom require imaging to evaluate for complications. Ultrasound has high accuracy in evaluating for cellulitis complicated with an abscess. For more complicated life-threatening deep soft tissue infection (e.g., necrotizing fasciitis), early surgical evaluation is crucial and should not be delayed. Imaging with post contrast CT or MRI has a role in clinically indeterminate cases with more indolent course to evaluate for signs of deep soft tissue infection.

Keywords

Hematogenous osteomyelitis Osteomyelitis Diabetic pedal osteomyelitis Sickle cell disease Septic arthritis Cellulitis Necrotizing fasciitis Soft tissue abscess Emergency imaging Evidence-based imaging 

Abbreviations

FSE

Fast spin echo

MDP

Methylene diphosphonate

SE

Spin echo

SPECT

Single photon emission computed tomography

STIR

Short tau inversion recovery

Notes

Acknowledgments

The authors would like to acknowledge the work of Drs. John Y. Kim and Diego Jaramillo, whose previous chapters [“Imaging of Hematogenous Osteomyelitis and Septic Arthritis in Children,” co-authored with Dr. Boaz Karmazyn, in Evidence-Based Imaging in Pediatrics (Medina LS et al., eds ; Springer Science; 2010); “Imaging of Acute Hematogenous Osteomyelitis and Septic Arthritis in Children and Adults” in Evidence-Based Imaging (Medina LS et al., eds; Springer Science; 2011)] served as starting points for this current chapter.

References

  1. 1.
    Blickman JG, et al. Eur Radiol. 2004;14:L55–64.CrossRefPubMedGoogle Scholar
  2. 2.
    Conrad DA. Pediatr Rev. 2010;31(11):464–71.CrossRefPubMedGoogle Scholar
  3. 3.
    Dodwell ER. Curr Opin Pediatr. 2013;25(1):58–63.CrossRefPubMedGoogle Scholar
  4. 4.
    Guillerman RP. Pediatr Radiol. 2013;43:S193–203.CrossRefPubMedGoogle Scholar
  5. 5.
    Karmazyn B. Semin Ultrasound CT MR. 2010;31(2):100–6.CrossRefPubMedGoogle Scholar
  6. 6.
    Song KM, Sloboda JF. JAAOS. 2001;9(3):166–75.PubMedGoogle Scholar
  7. 7.
    Labbé JL, et al. Orthop Traumatol Surg Res. 2010;96(3):268–75.CrossRefPubMedGoogle Scholar
  8. 8.
    Martínez-Aguilar G, et al. Pediatr Infect Dis J. 2004;23(8):701–6.CrossRefPubMedGoogle Scholar
  9. 9.
    Inusa BP, et al. PLoS One. 2013;8(6):e65001.CrossRefPubMedCentralPubMedGoogle Scholar
  10. 10.
    Berger E, et al. Arch Pediatr Adolesc Med. 2009;163(3):251–5.CrossRefPubMedGoogle Scholar
  11. 11.
    Offiah AC, Eur J. Radiology. 2006;60(2):221–32.Google Scholar
  12. 12.
    Schweitzer ME, et al. J Am Coll Radiol. 2008;5(8):881–6.CrossRefPubMedGoogle Scholar
  13. 13.
    Caird MS, et al. J Bone Joint Surg Am. 2006;88(6):1251–7.CrossRefPubMedGoogle Scholar
  14. 14.
    Kocher MS, et al. J Bone Joint Surg Am. 2004;86(8):1629–35.CrossRefPubMedGoogle Scholar
  15. 15.
    Montgomery CO, et al. J Pediatr Orthop. 2013;33(4):464–7.CrossRefPubMedGoogle Scholar
  16. 16.
    Perlman MH, et al. J Pediatr Orthop. 2000;20(1):40–3.PubMedGoogle Scholar
  17. 17.
    Phoenix GS, Joshi M. BMJ. 2012;345:e4955.CrossRefPubMedGoogle Scholar
  18. 18.
    Stevens DL, et al. Clin Infect Dis. 2005;41(10):1373–406.CrossRefPubMedGoogle Scholar
  19. 19.
    Paz Maya DBD, et al. Skeletal Radiol. 2014;43(5):577–89.CrossRefPubMedGoogle Scholar
  20. 20.
    Goh T, et al. Br J Surg. 2014;101(1):e119–25.CrossRefPubMedGoogle Scholar
  21. 21.
    Edlich RF, et al. J Emerg Med. 2010;39(2):261–5.CrossRefPubMedGoogle Scholar
  22. 22.
    Angoules AG, et al. Injury. 2007;38:S19–26.CrossRefPubMedGoogle Scholar
  23. 23.
    Schuster L, Nunez DE. Worldviews Evid-Based Nurs. 2012;9(2):88–99.CrossRefPubMedGoogle Scholar
  24. 24.
    Sarani B, et al. J Am Coll Surg. 2009;208(2):279–88.CrossRefPubMedGoogle Scholar
  25. 25.
    Ranson M. Sem Musculoskelet Radiol. 2009;13(3):277–99.CrossRefGoogle Scholar
  26. 26.
    Faust SN, et al. Arch Dis Child. 2012;97(6):545–53.CrossRefPubMedGoogle Scholar
  27. 27.
    Kothari NA, et al. Rad Clin N Am. 2001;39(4):653–71.CrossRefGoogle Scholar
  28. 28.
    Monsalve J, et al. AJR. 2015;204(6):1289–95.CrossRefPubMedGoogle Scholar
  29. 29.
    McNamara DR, et al. Mayo Clin Proc. 2007;82(7):817–21.CrossRefPubMedGoogle Scholar
  30. 30.
    Donovan SM. Rad Clin N Am. 2008;46(6):1105–24.CrossRefGoogle Scholar
  31. 31.
    Faucher LD, et al. Am J Surg. 2001;182:563–9.CrossRefPubMedGoogle Scholar
  32. 32.
    Mellado Santos JM. Eur Radiol. 2006;16(9):2109–19.CrossRefPubMedGoogle Scholar
  33. 33.
    Connolly LP, et al. J Nucl Med. 2002;43(10):1310–6.PubMedGoogle Scholar
  34. 34.
    Darge K, Siegel MJ. Eur J Radiol. 2008;68(2):289–98.CrossRefPubMedGoogle Scholar
  35. 35.
    Buhl T, et al. Clin Physiol Funct Imaging. 2005;25(1):20–6.CrossRefPubMedGoogle Scholar
  36. 36.
    Palestro CJ, et al. Radiographics. 2006;26(3):859–70.CrossRefPubMedGoogle Scholar
  37. 37.
    Filippi L, Schillaci O. J Nucl Med. 2006;47(12):1908–13.PubMedGoogle Scholar
  38. 38.
    Browne LP, et al. Pediatr Radiol. 2008;26(6):703–8.Google Scholar
  39. 39.
    Mazur JM, et al. J Pediatr Orthop. 1995;15:144–7.CrossRefPubMedGoogle Scholar
  40. 40.
    Malcius D, et al. Medicina (Kaunas). 2009;45(8):624–31.Google Scholar
  41. 41.
    Karmazyn B, et al. J Pediatr Orthop. 2007;27(2):158–64.CrossRefPubMedGoogle Scholar
  42. 42.
    Connolly SA, et al. AJR. 2007;189(4):867–72.CrossRefPubMedGoogle Scholar
  43. 43.
    Umans H, et al. Magn Reson Imaging. 2000;18(3):255–62.CrossRefPubMedGoogle Scholar
  44. 44.
    Browne LP, et al. AJR. 2012;198(1):194–9.CrossRefPubMedGoogle Scholar
  45. 45.
    Kan JH, et al. Pediatr Radiol. 2010;40(7):1197–205.CrossRefPubMedGoogle Scholar
  46. 46.
    Azam Q, et al. Acta Orthop Belgica. 2005;71(5):590–6.Google Scholar
  47. 47.
    Labbe JL, et al. Orthop Traumatol Surg Res. 2010;96(3):268–75.CrossRefPubMedGoogle Scholar
  48. 48.
    Bonhoeffer J, et al. Swiss Med Wkly. 2001;131(39–40):575–81.PubMedGoogle Scholar
  49. 49.
    Prandini N, et al. Nucl Med Commun. 2006;27(8):633–44.CrossRefPubMedGoogle Scholar
  50. 50.
    Wolf G, et al. Nucl Med Commun. 2001;22(11):1201–6.CrossRefPubMedGoogle Scholar
  51. 51.
    Stumpe KD, Strobel K. Semin Nucl Med. 2009;39(1):27–35.CrossRefPubMedGoogle Scholar
  52. 52.
    Palestro CJ. Semin Nucl Med. 2015;45(1):32–46.CrossRefPubMedGoogle Scholar
  53. 53.
    Thang SP, et al. Semin Musculoskelet Radiol. 2014;18(2):194–202.CrossRefPubMedGoogle Scholar
  54. 54.
    Palestro CJ. Semin Nucl Med. 2013;43(5):367–76.CrossRefPubMedGoogle Scholar
  55. 55.
    Stumpe KD, Strobel K. Q J Nucl Med Mol Imaging. 2006;50(2):131–42.PubMedGoogle Scholar
  56. 56.
    Rowe SP, Cho SY. Semin Musculoskelet Radiol. 2014;18(2):166–74.CrossRefPubMedGoogle Scholar
  57. 57.
    Strobel K. Stumpe KD. Semin Musculoskelet Radiol. 2007;11(4):353–64.CrossRefPubMedGoogle Scholar
  58. 58.
    Kapoor A, et al. Arch Intern Med. 2007;167(2):125–32.CrossRefPubMedGoogle Scholar
  59. 59.
    Ledermann HP, Schweitzer ME. Radiology. 2002;224(3):747–55.CrossRefGoogle Scholar
  60. 60.
    Donovan A. Radiographics. 2010;30(3):723–36.CrossRefPubMedGoogle Scholar
  61. 61.
    Marti-Carvajal AJ, et al. Cochrane Database Syst Rev. 2012;12:CD007175.PubMedGoogle Scholar
  62. 62.
    Ejindu VC, et al. Radiographics. 2007;27(4):1005–21.CrossRefPubMedGoogle Scholar
  63. 63.
    Jain R, et al. Clin Radiol. 2008;63(1):59–70.CrossRefPubMedGoogle Scholar
  64. 64.
    William RR, et al. Clin Radiol. 2000;55(4):307–10.CrossRefPubMedGoogle Scholar
  65. 65.
    Booz MM, et al. Clin Radiol. 1999;54(10):636–9.CrossRefPubMedGoogle Scholar
  66. 66.
    Baskett A, et al. Pediatr Emerg Care. 2009;25(2):78–82.CrossRefPubMedGoogle Scholar
  67. 67.
    Givon U, et al. J Pediatr Orthop. 2004;24(3):266–70.CrossRefPubMedGoogle Scholar
  68. 68.
    Shavit I, et al. Pediatr Emerg Care. 2006;22(8):570–3.CrossRefPubMedGoogle Scholar
  69. 69.
    Zamzam MM. J Pediatr Orthop. 2006;15(6):418–22.CrossRefGoogle Scholar
  70. 70.
    Yang WJ, et al. Pediatr Radiol. 2006;36(11):1154–8.CrossRefPubMedGoogle Scholar
  71. 71.
    Kwack KS, et al. AJR. 2007;189(2):437–45.CrossRefPubMedGoogle Scholar
  72. 72.
    Kim EY, et al. AJR. 2012;198(2):428–33.CrossRefPubMedGoogle Scholar
  73. 73.
    Volberg FM, et al. Pediatrics. 1984;74(1):118–20.PubMedGoogle Scholar
  74. 74.
    Jung ST, et al. J Pediatr Orthop. 2003;23(3):368–72.PubMedGoogle Scholar
  75. 75.
    Bickerstaff DR, et al. J Bone Joint Surg Br. 1990;72(4):549–53.CrossRefPubMedGoogle Scholar
  76. 76.
    Miralles M, et al. AJR. 1989;152(3):579–82.CrossRefPubMedGoogle Scholar
  77. 77.
    Plumb J, Bolte RG. Pediatr Emerg Care. 2015;31(1):54–8.CrossRefPubMedGoogle Scholar
  78. 78.
    Vieira RL. Ann Emerg Med. 2010;55:284–9.CrossRefPubMedGoogle Scholar
  79. 79.
    Grim PF. Clin Pediatr. 2014;53(5):486–9.CrossRefGoogle Scholar
  80. 80.
    Liberman B, et al. J Pediatr Orthop. 2013;33(2):124–7.CrossRefPubMedGoogle Scholar
  81. 81.
    Gordon JE, et al. J Pediatr Orthop. 2002;22(3):312–6.PubMedGoogle Scholar
  82. 82.
    Harish S, et al. Skelet Radiol. 2011;40(3):285–94.CrossRefGoogle Scholar
  83. 83.
    Learch TJ, Farooki S. Clin Imag. 2000;24(4):236–42.CrossRefGoogle Scholar
  84. 84.
    Margaretten ME, et al. JAMA. 2007;297(13):1478–88.CrossRefPubMedGoogle Scholar
  85. 85.
    Yeargan SA, et al. Curr Opin Rheumatol. 2008;20(4):457–62.CrossRefGoogle Scholar
  86. 86.
    Graif M, et al. Skelet Radiol. 1999;28(11):616–20.CrossRefGoogle Scholar
  87. 87.
    Karchevsky M, et al. Am J Roentgenol. 2004;182(1):119–22.CrossRefGoogle Scholar
  88. 88.
    Goldenberg DL, et al. Arthritis Rheum. 1975;18(1):83–90.CrossRefPubMedGoogle Scholar
  89. 89.
    Berger T, et al. Am J Emerg Med. 2012;30(8):1569–73.CrossRefPubMedGoogle Scholar
  90. 90.
    Iverson K, et al. Am J Emerg Med. 2012;30(8):1347–51.CrossRefPubMedGoogle Scholar
  91. 91.
    Ramirez-Schrempp D, et al. Pediatr Emerg Care. 2009;25(1):44–8.CrossRefPubMedGoogle Scholar
  92. 92.
    Tayal VS, et al. Acad Emerg Med. 2006;13(4):384–8.CrossRefPubMedGoogle Scholar
  93. 93.
    Gaspari R, et al. J Ultrasound Med. 2009;28(7):855–60.CrossRefPubMedGoogle Scholar
  94. 94.
    Gaspari R, et al. J Ultrasound Med. 2012;31(9):1405–11.CrossRefPubMedGoogle Scholar
  95. 95.
    Wall DB, et al. Am J Surg. 2000;179(1):17–21.CrossRefPubMedGoogle Scholar
  96. 96.
    Schmid MR, et al. AJR. 1998;170(3):615–20.CrossRefPubMedGoogle Scholar
  97. 97.
    Kim KT, et al. Radiology. 2011;259(3):816–24.CrossRefPubMedGoogle Scholar
  98. 98.
    Arslan A, et al. Eur J Radiol. 2000;36(3):139–43.CrossRefPubMedGoogle Scholar
  99. 99.
    Blankenship RB, Baker T. Emerg Med Clin North Am. 2007;25(1):223–34.CrossRefPubMedGoogle Scholar
  100. 100.
    Huang MN, et al. Internal Med J. 2009;39(12):841–4.CrossRefGoogle Scholar
  101. 101.
    Squire BT, et al. Acad Emerg Med. 2005;12(7):601–6.CrossRefPubMedGoogle Scholar
  102. 102.
    Unal O, et al. Eur J Radiol. 2011;77(3):490–4.CrossRefPubMedGoogle Scholar
  103. 103.
    Brothers TE, et al. J Am Coll Surg. 1998;187(4):416–21.CrossRefPubMedGoogle Scholar
  104. 104.
    Kalra MK, et al. Radiology. 2004;230(3):619–28.CrossRefPubMedGoogle Scholar
  105. 105.
    McCollough CH, et al. Radiographics. 2006;26(2):503–12.CrossRefPubMedGoogle Scholar
  106. 106.
    Raman SP, et al. J Am Coll Radiol. 2013;10(1):37–41.CrossRefPubMedGoogle Scholar
  107. 107.
    Greess H, et al. Eur Radiol. 2004;14(6):995–9.CrossRefPubMedGoogle Scholar
  108. 108.
    McGillicuddy EA, et al. J Trauma. 2011;70(4):894–9.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of RadiologyRiley Hospital for ChildrenIndianapolisUSA
  2. 2.Musculoskeletal ImagingIndiana University Methodist Hospital, Indiana University School of MedicineIndianapolisUSA
  3. 3.Department of Radiology and Imaging SciencesIndiana University Physicians-RadiologyIndianapolisUSA

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