Referensi :

1. Paul and Juhl's.1998. Essentials of Radiologic Imaging 7th ed. Lippincott Williams &
Wilkins Publishers : Mexico
2. Sutton, David.2003. Textbook of Radiology And Imaging, 7th ed.Vol.2. Elsevier Science :
London.

RADIOGRAPHIC FINDINGS IN ACUTE OSTEOMYELITIS

In acute osteomyelitis there is a latent period of 10 to 12 days between the time of onset of
clinical symptoms and the development of definite radiographic changes in
bone.14 Because it is essential that adequate therapy be instituted as early as possible, one
should not wait for the development of radiographic evidence of disease
before instituting appropriate treatment. Radioisotopic bone scanning is very sensitive to
the changes of osteomyelitis, revealing areas of increased radioactivity at
sites of infection well before there is any plain film radiographic sign of disease ( Fig. 5-3).
A bone scan is warranted in every case of clinically suspected osteomyelitis
in which the radiographs are unrevealing.

FIG. 5-3. Acute osteomyelitis of the left calcaneus in a child. A: Lateral radiograph
demonstrates no bony abnormality. Deep soft-tissue swelling is present adjacent to
the posterior and inferior surfaces of the calcaneus. B: Technetium-99m bone scan reveals focus
of increased activity in the left calcaneus. Bilateral increased activity
at the distal tibial epiphysis is normal. (Courtesy of James Conway, M.D., Chicago, Illinois.)
The first radiographic evidence of disease is the swelling of soft tissues, characteristically deep
and adjacent to bone ( Fig. 5-4; see Fig. 5-3A). The early swelling is
recognized because of displacement or obliteration of the normal fat planes adjacent to and
beneath the deep muscle bundles. At first the superficial fatty layer is
unaffected. In contrast, with skin infection, soft-tissue swelling is superficial and does not
involve the deeper tissues adjacent to the bone. The first evidence of
disease in the bone is usually an area of indefinite rarefaction or destruction in the metaphysis (
Fig. 5-5 and Fig. 5-6). The area of destruction is poorly defined and
has a fine, granular, or slightly mottled appearance. Associated with this or even at times
preceding it is a minimal amount of periosteal new-bone formation laid down
parallel to the outer margin of the cortex. The limits of the bone destruction remain poorly
defined throughout the acute stage. The actual disease process is usually
much more extensive than demonstrated by the radiograph.

FIG. 5-6. Acute osteomyelitis of the ulna. A: Examination obtained 10 days after the onset
of symptoms demonstrates permeative destruction of most of the ulna, with
periosteal new-bone formation surrounding the distal shaft and metaphysis. B: Repeat
examination 1 week later shows an increase in the amount of subperiosteal
new-bone formation. C: Examination 6 months later shows residual cortical thickening but
no definite areas of bone destruction.
In a short time, bone destruction becomes more prominent, causing a ragged, moth-eaten
appearance of the medullary bone, with foci of destruction intermingled with
areas of apparently more or less normal bone. Periosteal new-bone formation is more
pronounced, and both the periosteal reaction and intramedullary destruction
extend into the diaphysis (see Fig. 5-6). In the neonate, the infection commonly extends to
the overlying joint, forming a suppurative arthritis ( Fig. 5-7; see Fig. 3-5 and
Fig. 3-6).