A prospective study of soft-tissue ultrasonography in sickle cell disease patients with suspected osteomyelitis.
OBJECTIVE
A prospective study was done to assess the accuracy of soft tissue ultrasonography in patients with sickle cell disease (SCD) presenting with suspected osteomyelitis.


METHODS
Thirty-one SCD patients had soft tissue ultrasonography on 38 occasions (18 men, 13 women; mean age 8.2 years). The initial ultrasonographic signs and diagnosis were compared with the final clinical diagnosis, which was based on clinical progress and scintigraphy.


RESULTS
The overall sensitivity of ultrasound in diagnosing osteomyelitis was 74% with a specificity of 63%. The principal ultrasonographic finding of subperiosteal fluid was present in 14 (74%) patients with osteomyelitis and seven (37%) patients without infection. A finding of a subperiosteal fluid depth of 4 mm or more was significantly associated with osteomyelitis (P < 0.01).


CONCLUSIONS
Ultrasonography should be the initial investigation in SCD patients if osteomyelitis is suspected clinically. In such a clinical setting, a finding of 4 mm depth or more of subperiosteal fluid appears to be diagnostic. Previous statements that the presence of any subperiosteal fluid indicates infection are shown to be inaccurate. Patients with less than 4 mm of subperiosteal fluid require further imaging or aspiration to establish the diagnosis of osteomyelitis.
William
R R
RR
Departments of Radiology, Sultan Qaboos University Hospital, Sultanate of Oman.
Hussein
S S
SS
Jeans
W D
WD
Wali
Y A
YA
Lamki
Z A
ZA
D000293:Adolescent; D000328:Adult; D000755:Anemia, Sickle Cell / Q000150:complications / Q000000981:diagnostic imaging*; D001842:Bone and Bones / Q000098:blood supply; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005122:Exudates and Transudates / Q000000981:diagnostic imaging; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007238:Infarction / Q000000981:diagnostic imaging; D008297:Male; D009894:Opportunistic Infections / Q000150:complications / Q000000981:diagnostic imaging*; D010019:Osteomyelitis / Q000150:complications / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D014463:Ultrasonography