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Acute Osteomyelitis in Pediatrics. Jan Stauss S. Ted Treves, MD July 25, 2002. Patient Information. An otherwise Healthy 11year-old boy with increasing right knee pain and persistent fever for eight to nine days presents to the emergency room. Plain films of the right knee were negative.

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Acute Osteomyelitis in Pediatrics

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Acute osteomyelitis in pediatrics l.jpg

Acute Osteomyelitis in Pediatrics

Jan Stauss

S. Ted Treves, MD

July 25, 2002


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Patient Information

An otherwise Healthy 11year-old boy with increasing right knee pain and persistent fever for eight to nine days presents to the emergency room. Plain films of the right knee were negative.


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Imaging Information

A three phase bone scan was performed. The scan, at the region of the knees demonstrated increased blood flow to the region of the upper tibia


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The tissue phase image reveals increased tracer concentration in the same region.


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  • A whole body scan confirmed the abnormal tracer uptake in the right proximal tibia, just below the child’s epiphyseal growth plate

  • But no skeletal abnormalities were detected on the bone scans


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Diagnosis

  • Differential dianosis

    • Osteomyelitis

    • Cellulitis overlying bone

  • Diagnosis

    • Osteomyelitis of the right proximal tibia


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Other studies that can be done:

  • The most sensitivebut nonspecific laboratory studyto determine is the erythrocyte sedimentation rate. The white blood cell count is surprisingly normal in the majority of cases.

  • MRI is also helpful, when acute osteomyelitis does not respond to antibiotic therapy and localized abscess is suspected

  • When scintigraphy is normal but symptoms persist, the study should be repeated after 2 to 3 day

    • The three phase bone scan typically shows increased tracer delivery and localization on radionuclide angiographic and tissue-phase images and increased uptake on skeletal-phase images


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Brain Scan/Death

Gabriel Soudry, MD J Stevan Nagel, MD June 16, 1994


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Patient History

A 47-year-old man was working on his boat when he fell to the ground unconscious. He was taken to a local emergency ward where a head CT showed a large brainstem hemorrhage. The next day a brain death evaluation was begun and a brain scan was ordered


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Imaging Information

On Tc-99m HMPAO brain scintigraphy, the initial anterior flow study and subsequent planar views in the anterior and lateral projections demonstrate no appreciable intracerebral blood flow in either the internal carotid or posterior cerebral circulations


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Diagnosis

  • Brain death

    • Brain death is characterized by absent cerebral blood flow and global cerebral infarction. The brain scan can be used to confirm the absence of cerebral perfusion in suspected brain death. The study an be performed with intravenous bolus injection of Tc-99m HMPAO. Flow images are obtained in the anterior projection. Delayed images follow 5 to 10 minutes after the injection. Anterior and both lateral planar views are usually obtained. The diagnosis of brain death can be made only if intracranial activity is absent


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