Updates and Advances: Pediatric Musculoskeletal Infection Imaging Made Easier for Radiologists and Clinicians

Abstract

Infants and children often present with a wide range of musculoskeletal (MSK) infections in daily clinical practice. This can vary from relatively benign superficial infections such as cellulitis to destructive osseous and articular infections and life-threatening deep soft tissue processes such as necrotizing fasciitis. Imaging evaluation plays an essential role for initial detection and follow-up evaluation of pediatric MSK infections. Therefore, a clear and up-to-date knowledge of imaging manifestations in MSK infections in infants and children is imperative for timely and accurate diagnosis that, in turn, can result in optimal patient management. This article reviews an up-to-date practical imaging techniques, the differences between pediatric and adult MSK infections, the spectrum of pediatric MSK infections, and mimics of pediatric MSK infections encountered in daily clinical practice by radiologists and clinicians.

Keywords

musculoskeletal - infection - pediatric - magnetic resonance imaging - ultrasound

Publikationsverlauf

Artikel online veröffentlicht:
21. Mai 2021

• References

• 1 Dolitsky R, DePaola K, Fernicola J, Collins C. Pediatric musculoskeletal infections. Pediatr Clin North Am 2020; 67 (01) 59-69
• 2 Lee E. Pediatric Radiology: Practical Imaging Evaluation of Infants and Children. Philadelphia, PA: Lippincott Williams & Wilkins; 2017
• 3 Shahid M, Holton C, O'Riordan S, Kraft JK. Sonography of musculoskeletal infection in children. Ultrasound 2020; 28 (02) 103-117
• 4 Hryhorczuk AL, Restrepo R, Lee EY. Pediatric musculoskeletal ultrasound: practical imaging approach. AJR Am J Roentgenol 2016; 206 (05) W62-W72
• 5 Karmazyn B. Ultrasound of pediatric musculoskeletal disease: from head to toe. Semin Ultrasound CT MR 2011; 32 (02) 142-150
• 6 Connolly LP, Connolly SA, Drubach LA, Jaramillo D, Treves ST. Acute hematogenous osteomyelitis of children: assessment of skeletal scintigraphy-based diagnosis in the era of MRI. J Nucl Med 2002; 43 (10) 1310-1316
• 7 Kwatra NS, Sarma A, Lee EY. Practical indication-based pediatric nuclear medicine studies: update and review. Radiol Clin North Am 2017; 55 (04) 803-844
• 8 Browne LP, Mason EO, Kaplan SL, Cassady CI, Krishnamurthy R, Guillerman RP. Optimal imaging strategy for community-acquired Staphylococcus aureus musculoskeletal infections in children. Pediatr Radiol 2008; 38 (08) 841-847
• 9 Kwatra NS, Lim R, Gee MS, States LJ, Vossough A, Lee EY. PET/MR imaging. Magn Reson Imaging Clin N Am 2019; 27 (02) 387-407
• 10 Schmitt SK. Osteomyelitis. Infect Dis Clin North Am 2017; 31 (02) 325-338
• 11 Funk SS, Copley LAB. Acute hematogenous osteomyelitis in children: pathogenesis, diagnosis, and treatment. Orthop Clin North Am 2017; 48 (02) 199-208
• 12 Riise ØR, Kirkhus E, Handeland KS. et al. Childhood osteomyelitis—incidence and differentiation from other acute onset musculoskeletal features in a population-based study. BMC Pediatr 2008; 8: 45
• 13 Congedi S, Minotti C, Giaquinto C, Da Dalt L, Donà D. Acute infectious osteomyelitis in children: new treatment strategies for an old enemy. World J Pediatr 2020; 16 (05) 446-455
• 14 Peltola H, Pääkkönen M. Acute osteomyelitis in children. N Engl J Med 2014; 370 (04) 352-360
• 15 Kanavaki A, Ceroni D, Tchernin D, Hanquinet S, Merlini L. Can early MRI distinguish between Kingella kingae and gram-positive cocci in osteoarticular infections in young children?. Pediatr Radiol 2012; 42 (01) 57-62
• 16 Desimpel J, Posadzy M, Vanhoenacker F. The many faces of osteomyelitis: a pictorial review. J Belg Soc Radiol 2017; 101 (01) 24
• 17 Thakolkaran N, Shetty AK. Acute hematogenous osteomyelitis in children. Ochsner J 2019; 19 (02) 116-122
• 18 Pugmire BS, Shailam R, Gee MS. Role of MRI in the diagnosis and treatment of osteomyelitis in pediatric patients. World J Radiol 2014; 6 (08) 530-537
• 19 Markhardt BK, Woo K, Nguyen JC. Evaluation of suspected musculoskeletal infection in children over 2 years of age using only fluid-sensitive sequences at MRI. Eur Radiol 2019; 29 (10) 5682-5690
• 20 Lee YJ, Sadigh S, Mankad K, Kapse N, Rajeswaran G. The imaging of osteomyelitis. Quant Imaging Med Surg 2016; 6 (02) 184-198
• 21 Yeo A, Ramachandran M. Acute haematogenous osteomyelitis in children. BMJ 2014; 348: g66
• 22 Davies AM, Hughes DE, Grimer RJ. Intramedullary and extramedullary fat globules on magnetic resonance imaging as a diagnostic sign for osteomyelitis. Eur Radiol 2005; 15 (10) 2194-2199
• 23 Smith BJ, Buchanan GS, Shuler FD. A comparison of imaging modalities for the diagnosis of osteomyelitis. Marshall J Med 2016; 2 (03) 83
• 24 Rodriguez-Takeuchi SY, Renjifo ME, Medina FJ. Extrapulmonary tuberculosis: pathophysiology and imaging findings. Radiographics 2019; 39 (07) 2023-2037
• 25 Teo HEL, Peh WCG. Skeletal tuberculosis in children. Pediatr Radiol 2004; 34 (11) 853-860
• 26 Tuli SM. General principles of osteoarticular tuberculosis. Clin Orthop Relat Res 2002; (398) 11-19
• 27 De Backer AI, Mortelé KJ, Vanhoenacker FM, Parizel PM. Imaging of extraspinal musculoskeletal tuberculosis. Eur J Radiol 2006; 57 (01) 119-130
• 28 Raff AB, Kroshinsky D. Cellulitis: a review. JAMA 2016; 316 (03) 325-337
• 29 Galli L, Venturini E, Bassi A. et al; Italian Pediatric Infectious Diseases Society, Italian Pediatric Dermatology Society. Common community-acquired bacterial skin and soft-tissue infections in children: an intersociety consensus on impetigo, abscess, and cellulitis treatment. Clin Ther 2019; 41 (03) 532-551.e17
• 30 Adhikari S, Blaivas M. Sonography first for subcutaneous abscess and cellulitis evaluation. J Ultrasound Med 2012; 31 (10) 1509-1512
• 31 Loyer EM, DuBrow RA, David CL, Coan JD, Eftekhari F. Imaging of superficial soft-tissue infections: sonographic findings in cases of cellulitis and abscess. AJR Am J Roentgenol 1996; 166 (01) 149-152
• 32 Zundel S, Lemaréchal A, Kaiser P, Szavay P. Diagnosis and treatment of pediatric necrotizing fasciitis: a systematic review of the literature. Eur J Pediatr Surg 2017; 27 (02) 127-137
• 33 Bingöl-Koloğlu M, Yildiz RV, Alper B. et al. Necrotizing fasciitis in children: diagnostic and therapeutic aspects. J Pediatr Surg 2007; 42 (11) 1892-1897
• 34 Schröder A, Gerin A, Firth GB, Hoffmann KS, Grieve A, Oetzmann von Sochaczewski C. A systematic review of necrotising fasciitis in children from its first description in 1930 to 2018. BMC Infect Dis 2019; 19 (01) 317
• 35 O'Regan K, O'Mahony E, MacEneaney P, Fitzgerald E, Maher MM. Fulminant limb and retroperitoneal necrotizing fasciitis in a 15-year-old girl with Fanconi anaemia. Pediatr Radiol 2009; 39 (10) 1095-1097
• 36 Ali SZ, Srinivasan S, Peh WCG. MRI in necrotizing fasciitis of the extremities. Br J Radiol 2014; 87 (1033): 20130560
• 37 Kim K-T, Kim YJ, Won Lee J. et al. Can necrotizing infectious fasciitis be differentiated from nonnecrotizing infectious fasciitis with MR imaging?. Radiology 2011; 259 (03) 816-824
• 38 Hayeri MR, Ziai P, Shehata ML, Teytelboym OM, Huang BK. Soft-tissue infections and their imaging mimics: from cellulitis to necrotizing fasciitis. Radiographics 2016; 36 (06) 1888-1910
• 39 Mitsionis GI, Manoudis GN, Lykissas MG. et al. Pyomyositis in children: early diagnosis and treatment. J Pediatr Surg 2009; 44 (11) 2173-2178
• 40 Bureau NJ, Chhem RK, Cardinal E. Musculoskeletal infections: US manifestations. Radiographics 1999; 19 (06) 1585-1592
• 41 Soler R, Rodríguez E, Aguilera C, Fernández R. Magnetic resonance imaging of pyomyositis in 43 cases. Eur J Radiol 2000; 35 (01) 59-64
• 42 Yang WJ, Im SA, Lim GY. et al. MR imaging of transient synovitis: differentiation from septic arthritis. Pediatr Radiol 2006; 36 (11) 1154-1158
• 43 Marchal GJ, Van Holsbeeck MT, Raes M. et al. Transient synovitis of the hip in children: role of US. Radiology 1987; 162 (03) 825-828
• 44 Karchevsky M, Schweitzer ME, Morrison WB, Parellada JA. MRI findings of septic arthritis and associated osteomyelitis in adults. AJR Am J Roentgenol 2004; 182 (01) 119-122
• 45 Kocher MS, Zurakowski D, Kasser JR. Differentiating between septic arthritis and transient synovitis of the hip in children: an evidence-based clinical prediction algorithm. J Bone Joint Surg Am 1999; 81 (12) 1662-1670
• 46 Arvikar SL, Steere AC. Diagnosis and treatment of Lyme arthritis. Infect Dis Clin North Am 2015; 29 (02) 269-280
• 47 Ecklund K, Vargas S, Zurakowski D, Sundel RP. MRI features of Lyme arthritis in children. AJR Am J Roentgenol 2005; 184 (06) 1904-1909
• 48 Sato TS, Watal P, Ferguson PJ. Imaging mimics of chronic recurrent multifocal osteomyelitis: avoiding pitfalls in a diagnosis of exclusion. Pediatr Radiol 2020; 50 (01) 124-136
• 49 Khanna G, Sato TSP, Ferguson P. Imaging of chronic recurrent multifocal osteomyelitis. Radiographics 2009; 29 (04) 1159-1177
• 50 Parnell SE, Parisi MT. Caffey disease. Pediatr Radiol 2010; 40 (Suppl. 01) S39