NHIỄM TRÙNG: VIÊM XƯƠNG & VIÊM KHỚP CHẨN ĐOÁN Ill Child • This child is systemically ill from septic arthritis Note the lethargy and dehydration Infection causes systemic illness • This infant has septic arthritis of the elbow and is systemically ill Local spread • Infection from metaphyseal osteomyelitis may spread into adjacent joints in the infant Soft tissue swelling • Soft tissue swelling is present in this infant with septic arthritis of the elbow Neonatal septic arthritis of the hip • Note the widening of the joint space This is a late finding False negative radiograph • The radiograph was read as negative, no treatment was given, and the hip was destroyed by the septic arthritis Cellulitis involving the hip • This child has cellulitis about the left hip (arrow) The limb is held in a position of flexion and abduction that reduces soft tissue pressure and minimizes discomfort Osteomyelitis • This boy has osteomyelitis of the upper tibia with an associated soft tissue abscess (arrow) CRP and ESR changes with time • Following a musculoskeletal infection, the CRP declines more rapidly than the ESR 10 Chronic osteomyelitis in a 12-year-old boy • The sequestrum is clearly shown on the lateral radiograph (red arrows) and CT scan (yellow arrow) Note the overgrowth and valgus deformity of the right tibia (green lines) 21 Sclerosing osteomyelitis • The entire shaft of the femur was converted into an abscess cavity in this adolescent boy 22 Unusual forms of osteomyelitis • Chronic osteomyelitis of the clavicle produces bony overgrowth with a cystic appearance, often confused with a neoplasm (red arrow) Rarely, lesions occur in the epiphysis (yellow arrow) A metaphyseal lesion was also present (white arrow) 23 Sites of infec tions about the pelvis • Consider these possibilities in the differential diagnosis 24 Sacroiliac joint infection • Initial radiographs were negative, but a bone scan demonstrated involvement of the SI joint (red arrow) Radiographs one month later demonstrated a bone abscess (yellow arrow) 25 Foreign body infections • The foot is swollen but without bony change The ultrasound shows the wood fragment (yellow arrow) 26 Unilateral chronic recurrent multifocal osteomyelitis • Note the unilateral right distal femoral metaphysis involvement (red arrows) The left femur (green arrows) is not affected 27 Bilateral chronic recurrent multifocal osteomyelitis • This atypical form of osteomyelitis produces symmetrical bone lesions in early disease before radiographic findings (top) and two months later when extensive metaphyseal changes are seen (bottom, red arrows) 28 Salmonella osteomyelitis in sickle cell disease • This osteomyelitis elicits an extensive subperiosteal new bone formation (red arrows) that completely surrounds the original diaphysis (yellow arrows) 29 Tuberculous spondylitis with kyphosis • This was a common condition in the past (red arrow) in North America, and it is still prevalent in developing countries (yellow arrow) 30 Tuberculous paravertebral abscess • The abscess can be seen both on the chest radiograph and the CT scan (red arrows) 31 Tuberculous hip infection • Note that the infection involves the proximal femur (white arrow), joint (yellow arrow), and acetabulum (red arrow) 32 Polymyositis • Note the soft tissue swelling (red arrow) and increased 33 muscle uptake (yellow arrow) on bone scan Distribution of septic arthritis • From data of Jackson and Nelson (1982) 34 Organisms in septic arthritis • These organisms are listed according to relative frequency 35