Acute Haematogenous Osteomyelitis in Children - the Reliability of Skeletal Scintigraphy

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Abstract
Thirty-nine bone scans were performed in children (1 wk to 14 yr of age), with symptoms and signs of acute osteomyelitis. All but 2 scintigrams were obtained within the 1st wk of the disease. Nine scans showed locally increased isotope accumulation. The diagnosis of osteomyelitis was later confirmed by radiological examination or by positive cultures. Twenty-nine scans were reported negative, yet 4 patients developed characteristic radiological signs of osteomyelitis. In 1 of these 4 cases a decreased uptake (cold lesion) in the scintigram was overlooked. In spite of surgical drainage the patient developed chronic osteomyelitis. Bone scanning is a valuable adjunct in the early diagnosis of osteomyelitis. A negative scintigram does not exclude this diagnosis. A cold lesion may indicated a high pressure abscess and a risk for sequestrum formation. Prompt surgical drainage is advocated when such lesions are encountered in the scintigram.

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