Abstract: Introduction: the diagnosis of osteomyelitis in children and adolescents in early stages is the key to successful treatment of this formidable disease. Timely treatment will avoid a deterioration in the quality of life of patients, which is extremely important for adolescent patients. In recent decades, there has been an increase in the percentage of patients with osteomyelitis in childhood and adolescence. Non-specific clinical manifestations of the disease and the absence of manifestations on radiographs for a long time lead to an incorrect interpretation of clinical and radiological data. Aim: was to demonstrate possibilities of magnetic resonance imaging (MRI) and ultrasound (ultrasound) in diagnosis of osteomyelitis in case of adverse anatomical localization. Material and methods: we present a case report of complex radiation diagnosis of inflammatory lesions of the musculoskeletal system of adverse anatomical localization in a teenager. Clinically patient suffered from severe pain in left hip joint with pain radiation to the left thigh, limitation of movements in the joint concerned, swelling of soft tissues of the left thigh and gluteal region against the background of hyperthermia. Results: according to data of digital radiography, the patient did not reveal signs of the destructive process of bone tissue. Changes in the form of psoit and coxitis were detected by ultrasound. Examination was supplemented by MRI, according to which on T2 FatSat in coronal and axial projections the left-sided synovitis was confirmed, without inflammatory changes in the bone tissue. 10 days after, MRI revealed inflammatory changes in the bone marrow of the head of left femur, left pubic and iliac bones, adjacent soft tissues and left-sided synovitis, regarded as a manifestation of acute hematogenous osteomyelitis. Patient underwent surgical and symptomatic treatment with a positive result. Conclusions: 1. Absence of pathological changes according to x-ray examinations in children and adolescents (radiography and MSCT) does not exclude the presence of osteomyelitis, due to the absence of manifestations on radiographs for a long time. 2. At early stages of disease, especially in young children, as well as at stages of conservative and surgical treatment, the most appropriate use of ultrasound and MRI. 3. Conducting MSCT is advisable after obtaining ultrasound and MRI data on the presence of bonedestructive changes. References 1. Bruchanov AV, Vasiliev AYu. Magnetic resonance imaging in osteology. Publishing house «Medicine», 2006; 200. [In Russ]. 2. Trufanov GE, Fokin VA. Features of the application of radiation diagnostic methods in pediatric practice. Vestnik sovremennoj klinicheskoj mediciny.2013; 6(6): 48–52 [In Russ]. 3. Peltola H, Paakkonen M. Acute Osteomyelitis in Children. N Engl J Med 2014; 370: 352-360. 4. Basu S, Chryssikos T, Moghadem-Kia S, Zhuang H, Torigian DA, Alavi A. Positron emisson tomography as a diagnostic tool in infection: present role and future possibilities. Semin. Nucl. Med. 2009; 39 (1): 36-51 5. Vasiliev AYu, Olkhova EB. Fundamentals of ultrasound diagnostics in pediatrics and pediatric surgery. M. 2019: 171-190 [In Russ].
Abstract: Results of minimal invasive percutaneus drainage interventions under US-control in 45 children, aged 1-4 years with intraabdominal abscesses of different genesis are presented. Intraabdominal abscesses were identified as subdiaphragmatic (16), intrafilar (22) and pelvic (19). Difference between US-characteristics of intraabdominal abscesses, preoperative planning peculiarities and interventional technologies, that depend on localization of abscesses are presented. The usage of 3D-echography results data in 13,3% of children increased the value of diagnostics: for optimization of surgical approach, kind and volume of intervention. Percutaneus drainage intervention under ultrasound control is effective and non-traumatic method of treatment. References 1. Libov S.L. Localised peritonitis in children L., Medicina. 1983:184 [In Russ]. 2. Evdokimova E.Ju. US diagnostic and therapeutic nterventions in patients with postoperative inflammatory outcomes. Abstract of dissertation for the degree «Doctor of Philosophy». Krasnojarsk. 2003: 298[In Russ]. 3. Barsukov M.G. Transcutaneus US-guided draining of abdominal cavity abscesses. Abstract of dissertation for the degree «Doctor of Philosophy». Moskva. 2003: 29 [In Russ]. 4. Judin Ja.B., Prokopenko, Ju.D., Fedorov, K.K., Gabinskaja T.A. Ostryj appendicit u detej Acute appendicitis in children. M.: Medicina. 1998: 256 [In Russ]. 5. Witinin V.E. Localised peritonitis of appendicular genesis in children. Hirurgija 1980; 7: 12-16 [In Russ]. 6. Dvorjakovskij I.V., Beljaeva O.A. 7. Beljaeva O.A., Lotov A.N., Musaev G.H., Rozinov V.M. US-guided mini-invasive interventions in children with urgent abdominal patology. Manual for physicians. M.: ANMI. 2002: 25 [In Russ]. 8. Pediatric surgery: national guidance. M.: «GJeOTAR-Media». 2009: 1168 [In Russ]. 9. Vajner Ju.S., Egorov A.B., Vardosanidze V.K. Treatment of abdominal cavity’ abscesses with the help of US-guided mini-invasive interventions. Scientific-practical conference «Transcutaneus and endoscopic interventions in surgery»: abstracts. Moskva. 2010: 48-49 [In Russ]. 10. Shulutko A.M., Nasirov F.N., Natroshvili A.G. Possibilities of US in diagnostics and treatment of abdominal cavity’ abscesses. Scientific-practical conference «Transcutaneus and endoscopic interventions in surgery»: abstracts. Moskva. 2010: 91-92 [In Russ]. 11. Kulezneva Ju.V., Izrailov R.E., Lemeshko Z.A. US in deiagnostics and treatment of acute appendicitis. Moskva: «GJeOTAR-Media». 2009: 72 [In Russ]. 12. Grigovich I.N., Derbenev V.V., Leuhin M.V. Vise conservatism in urgent pediatric surgery. Rossijskij vestnik detskoj hirurgii, anesteziologii i reanimatologii. 2011; 4: 16-19 [In Russ].
Abstract: Aim: was to study features of ultrasonic imaging of local and septic forms of acute hematogenic osteomyelitis (AHO) in children. Materials and methods: 59 patients with AHO, treated in Children's hospital No. 4 of Tomsk, for the period from 2000 to 2010 - were examined. All patients with suspicion on osteomyelitis (n = 59; 100%) underwent x-ray of defeated area and ultrasonic diagnostics on the Ultrasonix 2,6 with the use of linear sensor of 9-12 MHz. All patients with AHO underwent surgical operation (n=59; 100%). Results: 47 patients had local form of disease. Each patient had one phase of osteomyelitis. Extramedullary phase, the development of which was due to the disease duration - was prevalencing^^,^. Prevalence of quantity of AHO phases (n=19) over total number of patients with a septic forms of disease (n=12), reflected existence of multiple osteomyelitis in four patients. In each patient with septic form of the AHO we found defeat of several bones in identical or different phases of an inflammation. Conclusion: obtained results will help the earlier identification of AHO signs and determination of disease phase in patients with local and generalized forms of disease. All that will help to proceed modern sanation of osteomyelitic defeat. Reference 1. Abaev Ju.K., Adarchenko A.A., Zafranskaja M.M. Gnojnaja hirurgija detskogo vozrasta. Menjajushhiesja perspektivy [Contaminated surgery of childhood. Changing perspectives.]. Detskaja hirurgija. 2004; 6: 4-7 [In Russ]. 2. Beljaev M.K., Prokopenko Ju.D., Fedorov K.K. K voprosu o vybore lechebnoj taktiki pri metafizarnom osteomielite u detej [The issue of choice of therapeutic tactics in the metaphyseal osteomyelitis in children.]. Detskaja hirurgija. 2007;4:27-29 [In Russ]. 3. Lobanov Ju.A., Cap N.A., Nagornyj E.A. Osnovnye principy diagnostiki i lechenija ostrogo gematogennogo osteomielita u detej [The basic principles of diagnosis and treatment of acute osteomyelitis in children.]. Konsilium 2007 g. Ural'skaja gosudarstvennaja medicinskaja akademija: 56-59 [In Russ]. 4. Zavadovskaja V.D., Polkovnikova S.A., Perova T.B. Vozmozhnosti ul'trazvukovogo issledovanija v diagnostike ostrogo gematogennogo osteomielita u detej [Possibility of ultrasonography in the diagnosis of acute osteomyelitis in children.]. Ul'trazvukovaja i funkcional'naja diagnostika. 2006;4:67-75 [In Russ]. 5. Brjuhanov A.V. MR-tomograficheskaja semiotika zabolevanij kostno-sustavnogo apparata [MR tomographic semiotics of diseases of bone and articular apparatus.]. Materialy Ill regional'noj konferencii 28--30 ijunja 2004 goda. Tomsk. 2004;248-250 [In Russ]. 6. Kotljarov P.M., Sencha A.N., Beljaev D.V. Ul'tra-zvukovaja diagnostika osteomielita [Ultrasound diagnosis of osteomyelitis.]. Ul'trazvukovaja i funkcional'naja diagnostika. 2008;5:110-120 [In Russ]. 7. Tas F., Oguz S., Bulut O. et al. Comparison of the diagnosis of plain radiography ultrasonography and magnetic resonance imaging in early diagnosis of acute osteomyelitis experimentally formed on rabbits. Eur. J. Radiol. 2005; 56 (1): 107-112. 8. Fitoussi F., Litzelmann E., Ilharreborde B. et al. Hematogenous osteomyelitis of the wrist in children. J. Pediatr. (Orthop. 2007; 27(7): 810-813. 9. Marochko N.V., Pykov M.I., Zhila N.G. Ul'trazvukovaja semiotika ostrogo gematogennogo osteomielita u detej [Ultrasonic semiotics of acute hematogenic osteomyelitis in children.]. Ul'trazvukovaja i funkcional'naja diagnostika. 2006;4:55-66 [In Russ].
