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Musculoskeletal Infections: US Manifestations¹

¹ From the Department of Radiology, Hôpital Saint-Luc, Centre Hospitalier de l'Université de Montréal, 1058 rue Saint-Denis, Montreal, Quebec, Canada H2X 3J4 (N.J.B., E.C.); and the Department of Diagnostic Radiology, National University Hospital of Singapore (R.K.C.). Presented as a scientific exhibit at the 1998 RSNA scientific assembly. Received February 8, 1999; revision requested March 19; final revision received June 17; accepted June 21. Address reprint requests to N.J.B.

One of the most important prognostic factors in patients with musculoskeletal infections is the delay in establishing therapy. Early diagnosis of septic arthritis requires analysis of joint fluid. Ultrasonography (US) is a rapid, portable, sensitive technique for confirming the presence of joint effusions. The study can be easily repeated for follow-up of lesions. US allows real-time guidance of fluid aspiration and can reduce the risk of contaminating other anatomic compartments, especially in the hands, wrists, and feet. Radiography provides complementary information and should be performed in conjunction with US. US is the imaging modality of choice for diagnosis of superficial abscesses. Dynamic compression with the US probe and color Doppler imaging can facilitate detection of superficial abscesses. US may help in the early diagnosis of osteomyelitis by demonstrating subperiosteal or juxtacortical fluid collections and by providing guidance for aspiration of these collections. Evaluation of osseous involvement requires additional imaging; a US examination with normal results does not allow exclusion of bone infection. US is not degraded by metallic artifact and may be useful in cases of osteomyelitis complicating metallic fixation in an extremity. After initial radiography, US can play an important role in the management of musculoskeletal infections.

Index Terms: Arthritis, septic, 40.20 • Bones, infection, 40.20 • Bones, US, 40.1298 • Muscles, infection, 40.20 • Muscles, US, 40.1298

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