Abstract
Background
Diagnosis of acute osteomyelitis in young children can be challenging due to the lack
of specific clinical signs and symptoms. Prompt diagnosis and treatment is essential
to prevent complications and to improve long-term prognosis and reduce the need for
operative intervention. Point-of-care ultrasound (POCUS) may be a useful tool to detect
early changes associated with osteomyelitis.
Case Report
A 26-month-old boy presented with 6 days of fever and 3 days of focal pain over the
right anterior lower ribs without swelling, erythema, or bony deformity, and negative
chest x-ray study. A POCUS was performed by the ultrasound fellows and revealed deep
soft tissue swelling, periosteal elevation, and increased vascular flow with color
Doppler. The patient was admitted to the pediatric service with infectious disease
consultation and started on antibiotics. Magnetic resonance imaging confirmed the
diagnosis of a right seventh anterior rib osteomyelitis, and the patient subsequently
improved and was discharged home.
Why Should an Emergency Physician Be Aware of This?
In this case, the use of POCUS in the emergency department heightened the suspicion
for acute osteomyelitis in a rare location and guided early diagnosis and treatment.
Keywords
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Article info
Publication history
Published online: October 04, 2019
Accepted:
March 27,
2019
Received in revised form:
March 12,
2019
Received:
February 2,
2019
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
