Citation, DOI, disclosures and article data
At the time the article was created Joachim Feger had no recorded disclosures.View Joachim Feger's current disclosures
At the time the article was last revised Shervin Sharifkashani had no recorded disclosures.View Shervin Sharifkashani's current disclosures
Subperiosteal abscesses refer to the subperiosteal spread of infection characterized by purulent encapsulated fluid collections within the subperiosteal space.
On this page:
Subperiosteal abscesses are more often seen in children than in adults 1,2.
Subperiosteal abscesses have been associated with the following conditions 1-4:
- panton-Valentine leucocidin (PVL) gene positive staphylococcal infections
- direct trauma or surgery
Clinical symptoms are those of osteomyelitis and include pain, focal tenderness and fever as well as elevated inflammatory markers.
Complications include 1,5:
Subperiosteal abscesses are collections of pus in the subperiosteal space located between the periosteum and the cortex with the vertex of both structures at the perichondrial junction 2-5.
Subperiosteal abscesses can be seen on ultrasound by demonstration of a low or mixed echogenic fluid collection that separates the echogenic cortex and periosteum 2-4.
CT will demonstrate an abnormal fluid collection of low attenuation within the subperiosteal space 3.
Similar to other types of abscess a subperiosteal abscess might display a penumbra sign, that is a hyperintense rim on native T1 that enhances after contrast administration 1.
Sometimes there might be fat globules within the subperiosteal abscess. The adjacent bone marrow might appear heterogeneous with areas of diminished contrast enhancement 4.
- abscess cavity: low to intermediate signal intensity
- periosteum: low signal intensity
- abscess cavity: high signal intensity
- periosteum: low signal intensity
T1 C+ (Gd)
- abscess cavity: low signal intensity/no enhancement
- periosteum: avid enhancement
The radiologist report should include a description of the following features:
- form, location and size of the fluid collection
- relation to the fasciae
- relation to tendons and joints
- relation to local nerves and vessels
Treatment and prognosis
A subperiosteal abscess is a significant negative prognostic finding that usually predicts surgical management in addition to intravenous antibiotics 1-3.
History and etymology
The pathogenesis of subperiosteal abscess formation has been significantly influenced by the work of the Spanish surgeon Josep Trueta in 1959 2,6.
A differential of a subperiosteal abscess includes 3:
- 1. Alaia E, Chhabra A, Simpfendorfer C et al. MRI Nomenclature for Musculoskeletal Infection. Skeletal Radiol. 2021;50(12):2319-47. doi:10.1007/s00256-021-03807-7 - Pubmed
- 2. Weenders S, Janssen N, Landman G, van den Berg F. Subperiosteal Abscess in a Child. Trueta's Osteomyelitis Hypothesis Undermined? Orthop Traumatol Surg Res. 2015;101(6):763-5. doi:10.1016/j.otsr.2015.07.005 - Pubmed
- 3. Labbé J, Peres O, Leclair O et al. Acute Osteomyelitis in Children: The Pathogenesis Revisited? Orthop Traumatol Surg Res. 2010;96(3):268-75. doi:10.1016/j.otsr.2009.12.012 - Pubmed
- 4. Jaramillo D, Dormans J, Delgado J, Laor T, St Geme J. Hematogenous Osteomyelitis in Infants and Children: Imaging of a Changing Disease. Radiology. 2017;283(3):629-43. doi:10.1148/radiol.2017151929 - Pubmed
- 5. Belthur M, Birchansky S, Verdugo A et al. Pathologic Fractures in Children with Acute Staphylococcus Aureus Osteomyelitis. J Bone Joint Surg Am. 2012;94(1):34-42. doi:10.2106/JBJS.J.01915 - Pubmed
- 6. Trueta J. The Three Types of Acute Haematogenous Osteomyelitis. The Journal of Bone and Joint Surgery British Volume. 1959;41-B(4):671-80. doi:10.1302/0301-620x.41b4.671