ABSTRACT
OBJECTIVE: The objective of this study was to evaluate the efficacy of ultrasound in the diagnosis of acute hematogenous osteomyelitis of long bones in pediatric patients. PATIENTS AND METHODS: A prospective study was performed in a tertiary care pediatric hospital. During 12 months we prospectively studied 46 patients with the clinical diagnosis of acute hematogenous osteomyelitis (AHO) of long bones at the Hospital Nacional de Niños in Costa Rica. In all patients ultrasound (US) was performed within 24-36 hours of admission, before any invasive diagnosis or therapeutic procedure was begun. RESULTS: In those without US findings, but with strongly suspected (AHO), a bone scan was done. Of these patients, 26/46 (57%) was female. The mean age was 6.8 years. Sixty-five percent (30/46) had US findings compatible with AHO affecting the tibia (13), femur (11), humerus (4), and radius (2). The findings included subperiostic fluid (10), periosteal thickening (14), subperiostic abscess (6) and thickening of subcutaneous tissues (26). Patients were surgically drained and puss was obtained from the bone in all 30. Two patients with negative US, but strongly suspected AHO had a bone scan that was negative. Patients with AHO were followed with US within 5-7 days of surgery and all 30 showed marked improvement. CONCLUSIONS: In this study, US showed 100% sensitivity and specificity for the diagnosis of AHO of long bones in pediatric patients. US are a sensitive and non-invasive procedure for the diagnosis and follow-up of AOH of long bones.