Evidence-Based Emergency Imaging for Acute Musculoskeletal Infections in Adults and Children: Osteomyelitis, Septic Arthritis, and Soft Tissue Infection

Abstract

Acute musculoskeletal infections may pose diagnostic challenges in the emergency department. Presentation and imaging findings depend on age, underlying disease, and pathogen. Acute hematogenous osteomyelitis is most common in young children. There are unique considerations in adults with type II diabetes mellitus with pedal osteomyelitis and in children with sickle cell disease. MRI (complementary with radiography) is the imaging modality of choice for diagnosis of osteomyelitis and evaluating for complications. Acute septic arthritis is a medical urgency, and prompt diagnosis with ultrasound or MRI is crucial to prevent irreversible joint destruction. Soft tissue infections are common and seldom require imaging to evaluate for complications. Ultrasound has high accuracy in evaluating for cellulitis complicated with an abscess. For more complicated life-threatening deep soft tissue infection (e.g., necrotizing fasciitis), early surgical evaluation is crucial and should not be delayed. Imaging with post contrast CT or MRI has a role in clinically indeterminate cases with more indolent course to evaluate for signs of deep soft tissue infection.