Scintigraphy and ultrasonography in differentiating osteomyelitis from bone infarction in sickle cell disease.

PURPOSE: To demonstrate the combined use of scintigraphy and ultrasonography (US) in differentiating osteomyelitis from bone infarction in sickle cell disease.

MATERIAL AND METHODS: Two patients with sickle cell disease were examined with a combination of bone, bone marrow, white blood cell and/or gallium scintigraphy and US.

RESULTS: The scintigraphic studies demonstrated areas of suspected osteomyelitis at the distal femur in both patients and at the proximal right tibia in one of them. US revealed subperiosteal fluid collections in these areas. Aspiration guided by US established the presence of pus at the femur in both instances, which was successfully treated with the US-guided insertion of a drainage catheter and aspiration only, respectively. Thick blood, due to bone infarction, was aspirated at the tibia.

CONCLUSION: The scintigraphic studies were useful in locating all areas of suspected osteomyelitis. The role of US was to confirm the presence of a subperiosteal fluid collection and to guide aspiration, which can show the distinction between a haematoma and an abscess.