Photopenic bone scan osteomyelitis: A clinical perspective

Eighty-one pediatric patients had nuclear bone-imaging studies confirmatory of osteomyelitis during the past 10 years. Seven (8.6%) of 81 had "cold" o steomyelitis. These seven patients were all toxic [mean temperature (T), 39 .9 degrees C; heart rate (HR), 145 beats/min], all had markedly elevated er ythrocyte sedimentation rates (mean ESR, 76 mm/h), and six of seven had bot h confirmatory bone and blood cultures. An patients required surgical inter vention. The average length of hospital stay for these seven patients was 3 2 days (range, 8-65 days), ii control group of matched patients with "hot" osteomyelitis was constructed for statistical evaluation. This analysis con firmed significantly increased temperature, resting pulse rate, ESR, length of hospital stay, and rate of surgical intervention in patients with cold versus hot osteomyelitis. Patients with osteomyelitis presenting as a cold defect on bone imaging appeared to have a more aggressive type of bone infe ction, often requiring aggressive medical and surgical intervention adequat ely to control this infectious process.