Acute haematogenous osteomyelitis in children - the reliability of skeletal scintigraphy.

Thirty-nine bone scans were performed in children (1 week - 14 years of age), with symptoms and signs of acute osteomyelitis. All but two scintigrams were obtained within the first week of the disease. Nine scans showed locally increased isotope accumulation. The diagnosis of osteomyelitis was later confirmed by radiological examination or by positive cultures. Twenty-nine scans were reported negative. Nevertheless, four patients developed characteristic radiological signs of osteomyelitis. In one of these four cases a decreased uptake ("cold" lesion) in the scintigram was over-looked. In spite of surgical drainage the patient developed chronic osteomyelitis. It is concluded that bone scanning is a valuable adjunct in the early diagnosis of osteomyelitis. A negative scintigram, however, does not exclude this diagnosis. A "cold" lesion may indicate a high pressure abscess and a risk for sequestrum formation. Prompt surgical drainage is advocated when such lesions are encountered in the scintigram.