title: Dilemma in differentiating between acute osteomyelitis and bone infarction in children with sickle cell disease: the role of ultrasound.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Paediatrics, Evelina Children's Hospital, Guy's and St. Thomas' National Health Service (NHS) Foundation Trust, London, United Kingdom. baba.inusa@gstt.nhs.uk
authors.forename: Baba P D
authors.initials: BP
authors.lastname: Inusa
authors.forename: Adeola
authors.initials: A
authors.lastname: Oyewo
authors.forename: Felicity
authors.initials: F
authors.lastname: Brokke
authors.forename: Gayathriy
authors.initials: G
authors.lastname: Santhikumaran
authors.forename: K Haran
authors.initials: KH
authors.lastname: Jogeesvaran
mesh_terms: D000208:Acute Disease; D000755:Anemia, Sickle Cell / Q000000981:diagnostic imaging* / Q000473:pathology; D001842:Bone and Bones / Q000000981:diagnostic imaging* / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007238:Infarction / Q000000981:diagnostic imaging* / Q000473:pathology; D008297:Male; D010019:Osteomyelitis / Q000000981:diagnostic imaging* / Q000473:pathology; D014463:Ultrasonography