Radiology, Vol 179, 725-729, Copyright © 1991 by Radiological Society of North America
Subperiosteal abscess in children: scintigraphic appearance
SJ Allwright, JH Miller and V Gilsanz
Division of Nuclear Radiology, Childrens Hospital Los Angeles, CA 90027.
A subperiosteal abscess is an uncommon complication of osteomyelitis in
childhood. Bone scanning is very sensitive for the detection of early
skeletal infection; however, a subperiosteal abscess has a different and
distinctive scintigraphic appearance. The usual increased tracer uptake of
osteomyelitis is overshadowed by the presence of a "cold" lesion on the
delayed views, probably due to interruption of the vascular supply of the
bone. Early recognition of the condition is important, as surgery is
indicated to prevent extensive bone necrosis and chronic osteomyelitis. In
suspected osteomyelitis, a central photopenic area is highly suggestive of
subperiosteal abscess; when such an area is seen, a computed tomographic
(CT) scan can be helpful in planning the surgical approach for drainage.
Plain radiographs may be unremarkable even when the bone scan and CT
findings are dramatic. Five such cases are presented, and a recommended
diagnostic approach is discussed that views the two procedures as
complementary.
