Hematogenous Osteomyelitis

It can be difficult to diagnose in pediatric patients due to the condition's often vague presentation - Hasan S Merali

Hematogenous Osteomyelitis
Hematogenous Osteomyelitis

image by: Hope and Healing International

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Acute Hematogenous Osteomyelitis in Children

“The X-ray was normal, so I did not pursue a diagnosis of osteomyelitis.”
X-rays are often normal in AHO, and non-specific changes are seen in only 15% to 58% of patients with AHO. X-rays have even less sensitivity in pelvic osteomyelitis. It typically takes ≥7 days for changes associated with osteomyelitis to be seen on X-ray.

“The WBC count and differential were unremarkable, so it couldn't have been osteomyelitis.”
WBC count is the least helpful of the inflammatory markers, with a sensitivity of 34% to 43% in AHO. ESR and CRP are most useful and are elevated in 73% to 100% and 70% to 100% of patients, respectively.

“I…

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Resources

 Acute Hematogenous Osteomyelitis in Children

Treatment failure is common in osteomyelitis, occurring in 4.7% of children in one study. Even in the absence of sequestra or abscess, appropriate treatment can fail for reasons that are poorly understood.

Starship

This guideline covers the diagnosis and management of acute septic arthritis and acute haematogenous osteomyelitis in infants and children.

NORD

Among children and teens, the long bones of the legs and arms are most frequently affected. In adults, osteomyelitis most often affects the vertebrae of the spine and/or the hips.

Ortho Bullets

Osteomyelitis in the pediatric population is most often the result of hematogenous seeding of bacteria to the metaphyseal region of bone. Diagnosis is generally made with MRI studies to evaluate for bone marrow edema or subperiosteal abscess.

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