US diagnosis of osteomyelitis

The pathologic hallmarks of acute hematogeneous osteomyelitis, periosteal elevation, subperiosteal edema, or microabscesses cannot be seen on radiographs. In the last 24 months, the authors have studied the role of US in displaying these changes. The study population consisted of 20 children suspected to have osteomyelitis; the asymptomatic limb was scanned for comparison. Pathologic features displayed included periosteal elevation, subperiosteal edema, and microabscesses; in this stage the radiographs were still normal. In older children, the bone cortex on the normal side shadowed as expected. However, the sound beam passed through the infected bone, displayed the marrow space, and depicted the endosteum of the farfield cortex