Dilemma in Differentiating between Acute Osteomyelitis and Bone Infarction in Children with Sickle Cell Disease: The Role of UltrasoundReportar como inadecuado




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Background

Distinguishing between acute presentations of osteomyelitis OM and vaso-occlusive crisis VOC bone infarction in children with sickle cell disease SCD remains challenging for clinicians, particularly in culture-negative cases. We examined the combined role of ultrasound scan USS, C - reactive protein and White blood counts WCC in aiding early diagnosis in children with SCD presenting acutely with non-specific symptoms such as bone pain, fever or swelling which are common in acute osteomyelitis or VOC.

Methods

We reviewed the records of all children with SCD who were discharged from our department from October 2003 to December 2010 with a diagnosis of osteomyelitis based on clinical features and the results of radiological and laboratory investigations. A case control group with VOC who were investigated for OM were identified over the same period.

Results

In the osteomyelitis group, USS finding of periosteal elevation and-or fluid collection was reported in 76% cases with the first scan day 0–6. Overall 84% were diagnosed with USS initial +repeat. 16% had negative USS. With VOC group, USS showed no evidence of fluid collection in 53-58 admissions 91%, none of the repeated USS showed any fluid collection. Mean C-reactive protein CRP, and white cell count WCC were significantly higher in the OM.

Conclusion

The use of Ultrasound in combination with CRP and WCC is a reliable, cost-effective diagnostic tool for differentiating osteomyelitis from VOC bone infarction in SCD. A repeat ultrasound and-or magnetic resonance imaging MRI scan may be is necessary to confirm the diagnosis.



Autor: Baba P. D. Inusa , Adeola Oyewo, Felicity Brokke, Gayathriy Santhikumaran, K. Haran Jogeesvaran

Fuente: http://plos.srce.hr/



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