Ultrasonic detection of osteomyelitis. Pathologic correlation in an animal model.

The authors correlated sonographic findings with histologic findings in a rabbit model of osteomyelitis. Staphylococcus aureus osteomyelitis was induced in the femora of 11 New Zealand white rabbits. The opposite leg was used as a control. Sonographic findings showed fluid adjacent to the bone in 11 cases. The fluid was believed to be an inflammatory exudate, and its presence suggested osteomyelitis. Pathologic analysis showed extraperiosteal purulent fluid adjacent to the cortex as well as histopathologic changes of osteomyelitis in the 11 rabbits. There was one false-positive sonographic diagnosis of osteomyelitis in a rabbit that had a soft tissue abscess adjacent to the cortex.

Osteomyelitis: detection with US.

To evaluate the role of ultrasound (US) in the detection of osteomyelitis, the authors prospectively studied 48 patients clinically suspected of having osteomyelitis. A sonographic diagnosis was made if fluid was seen directly in contact with bone, without intervening soft tissues. Twelve of the 48 patients were subsequently found to have osteomyelitis. In 10 of them, US demonstrated abnormal fluid adjacent to the bone. This fluid was thought to represent an inflammatory exudate dissecting in a subperiosteal and/or extraperiosteal location. Eight of the 48 patients had soft-tissue fluid collections. The rest of the patients either had no abnormalities or had cellulitis. The authors conclude that US can be useful in the detection of osteomyelitis.

Osteomyelitis: detection with US. Work in progress.

Ten patients with clinically suspected osteomyelitis were studied with ultrasound (US). Five patients had abnormalities detectable on sonograms. An abnormal fluid collection was demonstrated adjacent to the bone in three of these five. US-guided aspiration of the fluid in two of the three patients revealed purulent or infected fluid that was thought to represent an inflammatory exudate dissecting in a subperiosteal or extraperiosteal location. Findings from subsequent radiographic and scintigraphic studies confirmed the diagnosis of osteomyelitis in these three patients. The other two patients with abnormal sonographic results had collections of fluid that were separated from the bone by a variable amount of soft tissue. These collections were confined to the soft tissue and did not appear to arise from the bone. Aspiration revealed a soft-tissue abscess in one patient and a seroma in the second. Findings in this preliminary study suggest that fluid around the bone seen on sonograms may indicate acute osteomyelitis.

An unusual anatomic location of pancreatic masses.

By use of accepted criteria, all masses anterior to the splenic vein are thought to arise from the pancreas, whereas all masses posterior to the vein are attributed to other retroperitoneal organs. Three patients with pancreatic masses are presented. Since the mass was posterior to the splenic vein in these cases, a pancreatic origin did not originally suggest itself.

Ultrasound in the diagnosis of systemic candidiasis (renal and cranial) in very low birth weight premature infants.

Premature infants, (in whom prolonged hyperalimentation long term indwelling catheters are used), serve as the ideal hosts for overwhelming Candida sepsis. Two cases of disseminated Candidiasis were studied. Case 1 had sonographically enlarged and highly echogenic kidneys. Case 2 had diffusely enlarged echogenic kidneys with actual fungus balls in the collecting system. This infant also developed hydrocephalus with debris in the ventricular system and abnormal brain parenchymal echogenicity.

The role of ultrasonography in the detection of extrapulmonary tuberculosis in patients with acquired immunodeficiency syndrome (AIDS).

Three cases of extrapulmonary tuberculosis are presented. Retroperitoneal and periportal adenopathy were the major manifestation of the disease detected by ultrasonography in all three cases. All of the patients were subsequently diagnosed as having acquired immunodeficiency syndrome (AIDS). The lymphohematogenous dissemination of the disease and the diagnostic role of ultrasonography are discussed.