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].
