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January 26, 1976

Focal Bone Pain: Infection or Infarction?

Author Affiliations

From the Department of Radiology, Albert Einstein College of Medicine of Yeshiva University, and the Bronx Municipal Hospital Center, Bronx, NY.

JAMA. 1976;235(4):425-426. doi:10.1001/jama.1976.03260300049035

A LIMPING child complains of pain in a lower extremity, is febrile, and has localized soft tissue swelling and tenderness to deep palpation over the bone. Laboratory studies disclose a normal or slightly elevated white blood cell (WBC) count and an elevated erythrocyte sedimentation rate (ESR). Results of a roentgenographic examination demonstrate no pathologic findings.

This is a relatively common presentation in a pediatric emergency room. Does the child have osteomyelitis? Cellulitis? Bone infarct? Although blood cultures will be done, it is not desirable to delay therapy of bone infection while waiting for the results. Roentgenographic studies are not helpful since they may not show positive findings for a week or more.

The following cases illustrate the usefulness of radionuclide bone imaging in situations of this type.

Report of Cases 

Case 1.—  A 10-year-old boy had a limp and a swollen, hot, tender, painful left ankle of four days' duration