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

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Book cover Evidence-Based Emergency Imaging

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

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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.

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Abbreviations

FSE:

Fast spin echo

MDP:

Methylene diphosphonate

SE:

Spin echo

SPECT:

Single photon emission computed tomography

STIR:

Short tau inversion recovery

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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.

Author information

Authors and Affiliations

  1. Department of Radiology, Riley Hospital for Children, Indianapolis, IN, USA

    Boaz Karmazyn

  2. Musculoskeletal Imaging, Indiana University Methodist Hospital, Indiana University School of Medicine, Indianapolis, IN, USA

    Trenton D. Roth

  3. Department of Radiology and Imaging Sciences, Indiana University Physicians-Radiology, Indianapolis, IN, USA

    Trenton D. Roth

Authors
  1. Boaz Karmazyn
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  2. Trenton D. Roth
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Corresponding author

Correspondence to Boaz Karmazyn .

Editor information

Editors and Affiliations

  1. Department of Radiology, Division of Cardio-Thoracic Radiology, Michigan Medicine, Ann Arbor, MI, USA

    Aine Kelly

  2. Department of Radiology, Division of Cardio-Thoracic Radiology, Michigan Medicine, Ann Arbor, MI, USA

    Paul Cronin

  3. Department of Diagnostic, Interventional, and Pediatric Radiology Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland

    Stefan Puig

  4. Department of Radiology, University of Kentucky Children’s Hospital, Lexington, KY, USA

    Kimberly E. Applegate

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Karmazyn, B., Roth, T.D. (2018). Evidence-Based Emergency Imaging for Acute Musculoskeletal Infections in Adults and Children: Osteomyelitis, Septic Arthritis, and Soft Tissue Infection. In: Kelly, A., Cronin, P., Puig, S., Applegate, K. (eds) Evidence-Based Emergency Imaging. Evidence-Based Imaging. Springer, Cham. https://doi.org/10.1007/978-3-319-67066-9_32

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  • DOI: https://doi.org/10.1007/978-3-319-67066-9_32

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