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

  • Boaz KarmazynEmail author
  • Trenton D. Roth
Part of the Evidence-Based Imaging book series (Evidence-Based Imag.)


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.


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



Fast spin echo


Methylene diphosphonate


Spin echo


Single photon emission computed tomography


Short tau inversion recovery



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.


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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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