J Korean Orthop Assoc.  2009 Feb;44(1):145-150. 10.4055/jkoa.2009.44.1.145.

Delayed Diagnosis of Acute Hematogenous Osteomyelitis of the Acetabulum: Report of Two Cases

• Lee SS
• Choi SW
• Kwon SW
• Awe SI

• KMID: 2186391
• DOI: http://doi.org/10.4055/jkoa.2009.44.1.145

Abstract

Acute hematogenous osteomyelitis of the acetabulum is not a common disease with similar clinical symptoms and hematological findings to those of pyogenic arthritis of the hip joint. This symptom similarity might lead to a delayed diagnosis of the disease, and even to unnecessary surgery. We report two cases of acute hematogenous osteomyelitis of the acetabulum. One was a 13-year-old boy with non-specific radiological findings of the hip joint, who was initially diagnosed with fever of unknown origin. The other was an 11-year-old boy with hip joint pain and a recent history of minor trauma, which lead to a delayed diagnosis.

Keyword

Acetabulum; Osteomyelitis; Delayed diagnosis

MeSH Terms

Acetabulum
Adolescent
Arthritis
Child
Delayed Diagnosis
Fever of Unknown Origin
Hip Joint
Humans
Osteomyelitis
Unnecessary Procedures

Figure

• 

  Fig. 1 (A) T2 weighted magnetic resonance imaging of a 13-year-old boy (case 1) with pain in the right hip was normal. (B) T2 weighted magnetic resonance imaging, taken when the symptoms relapsed, shows an abscess pocket (arrow) at the acetabulum near the triradiate cartilage. Fluid collection is shown in the hip joint. (C) The middle two images are of the initial magnetic resonance images. At the pubic portion of the acetabulum (arrow), the signal intensity of the right side was low in T1 weighted image, and high in T2-weighted image compared to that of the left side. (D) The bottom two images were taken when the symptoms relapsed. The difference on T1 weighted image and T2 weighted image are definite. There was fluid collection in the right hip joint.

• 

  Fig. 2 A boy (case 2) age 11-year-old presented with a left hip joint pain and a recent minor trauma history. The abscess pocket with well-enhanced margins and cortical bone defect were shown on the T1 weighted axial (A) and coronal (B) magnetic resonance imaging taken from another hospital. The abscess had extended to the surrounding soft tissues (black arrow). On T2 weighted fat suppression axial (C) and coronal (D) magnetic resonance imaging, there was no fluid collection in the left hip joint and no specific findings were shown. On T2 weighted fat suppression axial (E) and coronal (F) magnetic resonance imaging taken after relapse, the abscess pocket with well-enhanced margins (white arrow) was still shown in the posterosuperior portion of the acetabulum.

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