title: Acute hematogenous osteomyelitis of the rib identified on bedside ultrasound.
abstract: BACKGROUND
  Osteomyelitis is a challenging and commonly considered diagnosis in the emergency department. Early recognition and treatment with appropriate antibiotic therapy is crucial to prevent complications.
  
  
  OBJECTIVE
  This case reviews relevant literature and typical ultrasound features of osteomyelitis. It highlights a previously undescribed and practical application of emergency department bedside ultrasonography, adding to the diagnostic armamentarium for this disease process.
  
  
  METHODS
  A 48-year-old woman presented with fever and left chest wall pain. She had been seen previously for a right axillary abscess requiring incision and drainage. Examination revealed a focal area of chest tenderness without cutaneous changes. Chest x-ray study and laboratory evaluation were nondiagnostic. Bedside ultrasound diagnosed acute hematogenous osteomyelitis of a rib.
  
  
  CONCLUSIONS
  Bedside ultrasound holds great promise in investigating osteomyelitis when suspicion is high and traditional initial testing is nondiagnostic. Further study is required to quantify this benefit in the emergency department setting and explore utility of negative results.
authors.affiliation: Department of Emergency Medicine, Denver Health Medical Center, Denver, Colorado.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Emiley
authors.affiliation: Department of Emergency Medicine, Denver Health Medical Center, Denver, Colorado; University of Colorado School of Medicine, Aurora, Colorado.
authors.forename: John L
authors.initials: JL
authors.lastname: Kendall
authors.affiliation: Department of Emergency Medicine, Denver Health Medical Center, Denver, Colorado; University of Colorado School of Medicine, Aurora, Colorado.
authors.forename: Jennifer W
authors.initials: JW
authors.lastname: Bellows
mesh_terms: D000208:Acute Disease; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008875:Middle Aged; D010019:Osteomyelitis / Q000000981:diagnostic imaging*; D019095:Point-of-Care Systems; D012272:Ribs / Q000000981:diagnostic imaging*; D014463:Ultrasonography
keywords: imaging; infectious diseases; osteomyelitis; rib; ultrasound