Osteomyelitis of the ribs in children: a rare and potentially challenging diagnosis

Abstract

BACKGROUND Rib osteomyelitis is rare in children and can mimic other pathologies. Imaging has a major role in the diagnosing rib osteomyelitis. OBJECTIVE To evaluate clinical presentation and imaging findings in children with rib osteomyelitis. MATERIALS AND METHODS We performed a retrospective (2009-2018) study on children with rib osteomyelitis verified by either positive culture or pathology. We excluded children with multifocal osteomyelitis or empyema necessitans. We reviewed medical charts for clinical, laboratory and pathology data, and treatment. All imaging modalities for rib abnormalities were evaluated for presence and location of osteomyelitis and abscess. We calculated descriptive statistics to compare patient demographics, clinical presentation and imaging findings. RESULTS The study group included 10 children (6 boys, 4 girls), with an average age of 7.3 years (range, 3 months to 15.9 years). The most common clinical presentations were fever (n=8) and pain (n=5). Eight children had elevated inflammatory indices (leukocytosis, erythrocyte sedimentation rate [ESR], C-reactive protein [CRP]). Localized chest wall swelling was found initially in six children and later in two more children. Rib osteomyelitis was suspected on presentation in only two children. All children had chest radiographs. Rib lytic changes were found on only one chest radiograph, in two of the four ultrasound studies, and in four of eight CTs. Bone marrow signal abnormalities were seen in all eight MRIs. In nine children the osteomyelitis involved the costochondral junction. Six children had an associated abscess. Staphylococcus aureus was cultured in eight children. Osteomyelitis was diagnosed based on pathology in one child with negative cultures. CONCLUSION While rib osteomyelitis is rare, imaging findings of lytic changes at the costochondral junction combined with a history of fever, elevated inflammatory markers or localized softtissue swelling in the chest should raise suspicion for this disease.

The Antistaphylococcal Activity of Amoxicillin/Clavulanic Acid, Gentamicin, and 1,8‐Cineole Alone or in Combination and Their Efficacy through a Rabbit Model of Methicillin‐Resistant Staphylococcus aureus Osteomyelitis

“…Furthermore, the spread of this infection to surrounding tissues is responsible for significant morbidity and healthcare costs each year [1]. In high-income countries, acute osteomyelitis occurs in about 1of 800,000 children per year [2] but it is considerably more common in low-and middle-income countries [3]. In Morocco, osteomyelitis is more common among children [4].…”

Successful Treatment with Antibiotics Alone for Infant Rib Osteomyelitis

“…In this case, the patient's mother did not notice chest swelling initially, and neither did the attending physicians. The general presentation of rib osteomyelitis has been reported as fever, chest or back pain, and an abscess [ 1 ]; however, other articles have reported that such findings are not always presented—instead, patients may display nonspecific clinical features [ 3 , 4 ]. Because of these nonspecific symptoms, the lack of local findings (such as redness and swelling), and the indolent lesion that often occurs in cases of rib osteomyelitis [ 3 ], it is difficult to diagnose this disease early.…”

“…The general presentation of rib osteomyelitis has been reported as fever, chest or back pain, and an abscess [ 1 ]; however, other articles have reported that such findings are not always presented—instead, patients may display nonspecific clinical features [ 3 , 4 ]. Because of these nonspecific symptoms, the lack of local findings (such as redness and swelling), and the indolent lesion that often occurs in cases of rib osteomyelitis [ 3 ], it is difficult to diagnose this disease early. This may lead to delays in treatment initiation compared with osteomyelitis affecting other parts, such as the long bones [ 2 – 4 ].…”

“…It occurs predominantly in the neonatal period and early childhood, making it difficult for patients to articulate their symptoms [ 2 ]. Pediatric rib osteomyelitis is more difficult to diagnose than osteomyelitis of other sites because often the earliest symptoms are nonspecific and lack local findings (such as redness and swelling) and may also present indolent lesions [ 3 ] that can further impede diagnosis. We present a case of an infant with rib osteomyelitis complicated with chest wall abscess.…”

Acute Hematogenous Osteomyelitis of the Rib in 14 Years Old Child: Clinical Case

“…В диагностике остеомиелита ребра наряду с подробным сбором анамнеза (наличие травм в анамнезе, сопутствующей патологии), физикальным обследованием и результатами лабораторных исследований (клинический и биохимический анализы крови, прокальцитониновый тест в случае высокой и продолжительной лихорадки) важную роль играют методы визуализации [7]. Однако результаты визуализации (рентгенография, компьютерная томография) у таких детей могут быть неспецифическими и часто имитировать другие патологии, в особенности на ранних стадиях заболевания [8]. Именно поэтому чаще данную патологию принимают за опухоли типа саркомы Юинга и гистиоцитоз или тяжелое течение пневмонии [9].…”