4
Referensi : 1. Pa ul and Juhl's. 1998 . Essentials of Radiologic Imaging 7 th ed . Lippincott Williams & Wil kins Publishers : Mexico . !utt on" #a$id . %%. Textbook of Radiology And Imaging, th ed.Vol.2. (lse$ier !cience : London. RADIOGRAPHIC FINDINGS IN ACUTE OSTEOMYELITIS In acute osteo!e"itis t#ere is a "atent $erio% of &' to &( %a!s )et*een t#e tie of onset of c"inica" s!$tos an% t#e %e+e"o$ent of %efinite ra%io,ra$#ic c#an,es in )one-&. /ecause it is essentia" t#at a%e0uate t#era$! )e institute% as ear"! as $ossi)"e1 one s#ou"% not *ait for t#e %e+e"o$ent of ra%io,ra$#ic e+i%ence of %isease )efore institutin, a$$ro$riate treatent- Ra%ioisoto$ic )one scannin, is +er! sensiti+e to t#e c#an,es of osteo!e"itis1 re+ea"in, areas of increase% ra%ioacti+it! at sites of infection *e"" )efore t#ere is an! $"ain fi" ra%io,ra$#ic si,n of %isease 2 Fi,- 3456- A )one scan is *arrante% in e+er! case of c"inica""! sus$ecte% osteo!e"itis in *#ic# t#e ra%io,ra$#s are unre+ea"in,- FIG- 345- )cute osteom*elitis o+ the le+t calcaneus in a child. A: Lateral radio,raph demonstrates no bon* abnormalit* . #eep so+t-tissue sellin, is present a d/acent to the posterior and in+erior sur+aces o+ the calcaneus. /: 0e chnetium-99m bone scan re$eals +ocus o+ increased acti$it* in the le+t calcaneus. ilateral increased acti$it* at the distal tibial ep iph*sis is normal. 23ourtes* o+ James 3ona*" M.#." 3hica,o" 4llinois.5 0he +irst radio,raphic e$idence o+ disease is the sellin, o+ so+t tissues" characteristicall* deep and ad/acent to bone 2 6i,. 7- see 6i,. 7- A5. 0he earl* sellin, is reco,nied because o+ displacement or obliteration o+ the normal +at planes ad/acent to an d beneath the deep muscle bundles. )t +irs t the super+icial +att* la*er is una++ected. 4n contrast" ith skin in+ection" so+t-tissue sellin, is super+icial and does not in$ol$e the deeper tissues ad/acent to the bone. 0he +irst e$idence o+ disease in the bone is usuall* an area o+ inde+inite rare+action or destruction in the metaph*sis 2 6i,. 7-7 and 6i,. 7-;5. 0he area o+ destruction is poorl* de+ined and has a +ine" ,ranular" or sli,htl* mottled appearance. )ssociated ith this or e$en at times precedin, it is a minimal amount o+ periosteal ne-bone +ormati on laid don parallel to the outer mar,in o+ the cortex. 0he limits o+ the bone destruction remain poorl* de+ined throu,hout the acute sta,e. 0he actual disease process is usuall* much more extensi$e than demonstrated b* the radio,raph.
