Concomitant septic arthritis and osteomyelitis of the hip in young children; a new pathophysiological hypothesis suggested by MRI enhancement pattern

BMC Medical Imaging

Research Article

Dimitri Ceroni¹  Mehrak Anooshiravani²  Laura Merlini² 

[1] Unit of Pediatric Orthopedics, University Hospital, Geneva, Switzerland;Unit of Pediatric Radiology Geneva University Hospital HUG, 6 Willy-Donzé, 1205, Geneva, Switzerland;

关键词: Septic Arthritis;    Enhancement Pattern;    Joint Effusion;    Ossification Center;    Epiphyseal Cartilage;   

DOI  :  10.1186/s12880-015-0057-0

 received in 2014-06-11, accepted in 2015-05-08,  发布年份 2015

来源: Springer

【 摘 要 】

BackgroundIn children, septic arthritis (SA) of the hip is either primary or concomitant with acute haematogenous osteomyelitis (AHO). However, seldom, patients with isolated SA at presentation, may later show osteomyelitis in the metaphysis. The aim of this study was to elaborate a physiopathological hypothesis based on the peculiar MRI findings to explain the onset of AHO after SA.MethodsCases of acute infection of the hip admitted between January 2010 and December 2013 were retrospectively reviewed to assess radiographic and MRI features, as well as bacteriological findings. Only children with isolated SA were included in this study, whereas cases of concomitant SA and AHO at presentation were excluded.ResultsTen patients met the inclusion criteria. Six (1–11 months) demonstrated, on the initial MRI, decreased perfusion on gadolinium enhanced fat-suppressed T1-weighted sequence of the femoral epiphysis and developed one month later metaphyseal AHO. Four (5–14 years) did not show decreased perfusion and did not develop AHO on follow-up. The type of germ involved influenced neither the type of enhancement pattern nor the outcome.ConclusionsAge under one year and decreased perfusion of the affected femoral epiphysis increases the risk of secondary AHO. Our study is the first report in human medicine supporting the physiopathological hypothesis described by Alderson et al. in an animal model: primary infection can originally affect the joint, then penetrate the epiphyseal cartilage, and finally spread into the metaphyseal region through transphyseal vessels present only in the first 12/18 months of life.

【 授权许可】

CC BY   
© Merlini et al.; licensee BioMed Central. 2015