Presentation
Fever with right leg pain, edema for the last 3 to 4 days.
Patient Data
There is no periosteal reaction/ bone lesion/ fracture/ dislocation. There is diffuse soft tissue edema involving the distal thigh and proximal leg.
The popliteal vein is filled with echoes and shows poor compressibility. There is an absence of flow in the vein.
There is subperiosteal fluid with echoes involving proximal tibial diaphysis without obvious cortical erosion. There is a normal amount of anechoic fluid in the suprapatellar region.
An anteromedial proximal leg incision was made. There was pus under the thickened periosteum. Pus was drained from the subperiosteal space. Few artificial drill holes were made in the local tibial cortex. Primary suturing was not done.
Case Discussion
A child presented with fever along with right leg pain and edema. Laboratory study revealed infection. The radiograph was negative for a periosteal reaction. However, the ultrasound showed subperiosteal fluid involving the proximal tibial diaphyseal region. Surgery was done within a few hours and confirmed subperiosteal pus. A gram stain was positive for cocci.
The case shows the importance of ultrasound in the early diagnosis of acute osteomyelitis.
Surgical details and intraoperative photos courtesy: Dr. Ritesh Patel (operating surgeon)
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