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Heather Borders, MD
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Subperiosteal Abscess

Case Detail

Anatomy: Musculoskeletal
Joseph Junewick, MD FACR
Diagnostic Category: Infectious-Inflammatory
Created: over 10 years ago
Updated: over 10 years ago
Tags: PEDS
Modality/Study Types: US
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Premature neonate with fever and upper extremity swelling.

Case Images


Subperiosteal Abscess


US – Organizing juxtametaphyseal subperiosteal collection.


Osteomyelitis in the neonatal period is usually hematogenous. The metaphyseal marrow is infected first and spreads quickly to the growth plate, epiphysis, joint and adjacent soft tissues. Fast growing bones such as the distal femur, proximal humerus, proximal tibia and distal radius are the most vulnerable.

In the neonatal intensive care unit, prematurity and the attendant complications often mask the initial infection and diagnosis can be delayed. Bone destruction is often contained by the formation of subperiosteal abscess and decompression into the soft tissues. Multifocal and joint involvement carry a poor prognosis. Group B streptococcus and E. coli are the most usual causative organisms.

Ultrasound findings in infants with musculoskeletal infection include deep soft tissue swelling, periosteal elevation, synovial thickening and irregularity, synovial effusion with echogenic debris, increased cartilaginous echogenicity, cortical erosion, and subperiosteal abscess.

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