Rib osteomyelitis in children. Early radiologic and ultrasonic findings

Abstract

The earliest radiographic changes of osteomyelitis in the long bones is deep-seated edema manifesting as soft tissue swelling and obliteration of the intermuscular planes adjacent to the affected bone. Similarly, the early change of rib osteomyelitis is pericostal edema demonstrated by soft tissue swelling of the thoracic wall accompanied by an adjacent inward pleural displacement. In both osteomyelitis of the rib and the long bones, the bony changes will appear 1-2 weeks later. Pericostal edema can be readily diagnosed by ultrasound scan. Pericostal edema, although non specific and can occur in other conditions, yet it is a strong warning sign, set within the overall clinical picture of osteomyelitis.

The value of sonography in the detection of osteomyelitis

“…As regards osteomyelitis, however, it has been known for a long time that at least 1 to 2 weeks must pass from the onset of the disease before local inflammatory destruction of the osseous tissue is demon- [16]. Thus, radiography is unable to provide the early diagnosis on which the therapy depends.…”

“…Thus, sonography is now also able to detect early changes in inflammatory osseous processes as soon as they have spread beyond the level of cortical bone [8,9,[14][15][16]. In acute hematogenous osteomyelitis the changes are demonstrable just 1 or 2 days after the onset of symptoms [15], albeit on condition that the sound can reach the affected area unimpeded by other structures.…”

Rib Osteomyelitis in a Pediatric Patient: Case Report and Review of the Literature

“…The diagnosis of rib osteomyelitis requires a high index of suspicion by the emergency physician, especially because the presentation can be non-specific 2 as in the case presented. Definitive diagnosis often requires advanced imaging such as computed tomography or MRI, or invasive testing such as biopsy or aspiration with culture, although ultrasound 12 and plain radiography 13 are potentially useful in the initial evaluation. As in the case presented, ultrasound has some role in identifying subperiosteal abscess.…”

Multifocal rib osteomyelitis in children: a case report and literature review

“…The routine chest X-rays sometimes failed to detect early skeletal disease and the diagnosis was often delayed until there was bone destruction with overlying soft tissue changes [ 8 ]. The early change of rib osteomyelitis that will appear usually 1–2 weeks later, is pericostal edema demonstrated by soft tissue swelling of the thoracic wall accompanied by an adjacent inward pleural displacement [ 9 ]. Pericostal edema can be readily diagnosed by ultrasound.…”