Hematogenous pelvic osteomyelitis in children. Clinical correlates of newer scanning methods

Abstract

The records of 18 children with hematogenous pelvic osteomyelitis seen over a four-year period were reviewed. The mean age of the patients was 7.8 years and their most common presenting symptoms were gait disturbance (present in 94%) and pain about the hip (61%) with only mild limitation of motion; 11 (61%) of 18 patients were afebrile at presentation. Although leukocytosis was uncommon, the erythrocyte sedimentation rate was almost always elevated (greater than 40 mm/hr in 94% of the patients). While initial plain roentgenograms were usually normal, gallium citrate Ga 67 and technetium Tc 99m oxidronate scintigrams were abnormal in all patients who underwent these studies. Computed tomography proved to be a useful complementary study to radionuclide scintigraphy, yielding positive findings in nine of 11 cases. Patients presented for medical care a median of 2.5 days after the onset of symptoms, whereas a longer period of time (median, 7.5 days) was required to establish the correct diagnosis after presentation for care. The only observed complications occurred in two patients in whom there was significant delay in institution of therapy. Prevention of complications from pelvic osteomyelitis lies in early recognition and appropriate treatment of the disease. In our experience, newer imaging techniques facilitate prompt diagnosis.