Diagnosis of osteomyelitis.

The early diagnosis of acute hematogenous osteomyelitis depends on a high index of suspicion whenever the physician is confronted with a child experiencing acute onset of bone pain or limited motion of an extremity, regardless of the presence or absence of signs of infection such as fever, local tenderness, redness, swelling or heat (Table 4). Early diagnosis is aided greatly by the use of plain radiography to exclude other conditions and radionuclide bone scans to detect evidence of inflammation at the site of bone pain. "High-tech" procedures such as CAT and MRI should be reserved for situations in which the diagnosis cannot be made by the simpler methods, such as osteomyelitis of the spine or pelvis, or when the anatomic detail provided by MRI is required for planning of surgery. It is very unlikely that CAT or MRI will every be required in the majority of cases of uncomplicated osteomyelitis in children.