Ultrasonography: Can it differentiate between vasoocclusive crisis and acute osteomyelitis in sickle cell disease?

We prospectively evaluated the results of ultrasonography in 53 patients of sickle cell disease suspected to have vasoocclusive crisis/acute hematogen ous osteomyelitis. The average age was 8.4 +/- 3.40 years (range, 1-14). Tw enty-six children were boys and 27 were girls. Seventeen (32%) patients had ultrasonographic changes that suggested acute osteomyelitis. The minimal w hite cell count was 7,200/mm(3), and maximal, 9,900/mm(3) (mean, 8,190/mm(3 )) in uninfected patients and in 17 patients, the mean was 10,300/mm(3) (7, 200-13,600/mm(3)). The mean erythrocyte sedimentation rate in uninfected pa tients was 32 for the first hour (19-36 mm), and in infected patients, it w as 43 for the first hour (35-58 mm). Pus culture was positive in all infect ed patients, and the infective organism was Salmonella enteriditis in eight , staphylococcal species in six (S. aureus in four and S. epidermidis in tw o), and Streptococcus species 1 and 2, anaerobic streptococci. All patients with vasoocclusive crisis were treated with analgesics and intravenous flu ids and did not require any further treatment. In patients with acute osteo myelitis, the treatment was incision, drainage and drilling of bone, and an tibiotic therapy. We conclude that ultrasonography clearly and decisively d ifferentiated acute osteomyelitis from vasoocclusive crisis in patients wit h sickle cell disease.