doyoudig
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Kaplan and UW obvioulsy contradict themselves, as Kaplan says X Ray alwasy initial step and UW says Bone Scan if Sx are less than 2 weeks
Has anyone else have more conclusive info on which should always be be the initial Test, regardless of the time frame???
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| Justice
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| | 05/22/07 - 09:26 PM
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| #2 |
I think plain x-ray should be taken first. In fact, FA says the same (I know that FA for CK isn't that terrific as FA1, but it is very useful as a core book)
Bone scan is sensitive but not specific.
FA also says that MRI is a TEST OF CHOICE.
I checked with some fellows on the ped hem/onco ward, and they say that X-ray (1) and MRI (2) are the current options they use... Bone scan is very helpful for chronic OM
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| NE
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| | 05/23/07 - 08:12 AM
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| #3 |
From UpToDate:
"Plain films should be the initial imaging study, but other tests are often required.
Computed tomography is used to evaluate an area in which there are focal findings on examination and negative plain films. The CT (with and without contrast) is very accurate at detecting cortical destruction, intraosseous gas, periosteal reaction, and soft tissue extension .
MRI is an alternative to CT and is especially useful in evaluating for osteomyelitis in the vertebrae and in the infected foot.
MRI provides useful anatomic detail in planning for surgical debridement, since it may show abscesses that need drainage, and can reduce the risk of operating on bland cellulitis. MRI can also delineate soft tissue/epidural involvement and spinal cord impingement, which cannot be seen on nuclear medicine images.
When evaluating the foot for osteomyelitis, MRI is as specific or more specific and more sensitive than technetium bone scan.
My conclusion- first is xray, and after depends on the localization , Ct/MRI depends of the what the hospital have and the disease's localization.
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| doyoudig
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thx guys!!
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| young_doc
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Justice wrote:
I think plain x-ray should be taken first. In fact, FA says the same
Actually FA says that X-Rays are often negative initially (p.185, 5th Edition). I don't see where it suggests taking an X-Ray first?
I came across this topic last week on UWorld, and it pretty much said the same thing: To use technetium bone scan in the early stages, because X-Ray can give you False Negatives in first 2 weeks.
For the Step 2 though, i think the cheaper test is always preferred?!!
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| usmle12
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i would like to add ...
yes 1> xray if negative
2>MRI for an area with significant swelling....and drainage sinuses cz bonescan is not good when significant tissue swelling plus for spinal osteomylitis its best
3>but if no swelling then bone scan can be used
hey guys i have exam in 1 wk i am realy worreid
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| Justice
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young_doc wrote:
Actually FA says that X-Rays are often negative initially (p.185, 5th Edition). I don't see where it suggests taking an X-Ray first?
I do not claim that it will be positive, do I?  The point I mentioned that it should be taken first, and if negative or not specific, you go to MRI...
From my experience, I wouldn't even suspect OM within first several days when x-ray would be negative... The most reasonable explanation for persistent inflammation would be resistance of the bug to Abs the Pt receives... To come up with this idea, you would like to see the persistent inflammation for 10-14 days, when x-ray turns up to be positive...
Edited by Justice on 05/25/07 - 04:17 PM
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| virgola82
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Dr Pestana (by the way he's great!) in his surgey lectures says to do the bone scan first because the x ray will be negative up to 2 weeks later or so.
So I guess that, if the pt comes complaining of a 3 week monoarticular pain with fever the xray is worthwhile, but if he's symptomatic since a week or so it's better to order bone scan first
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| doyoudig
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Dr Pestana sucks, n so do his lectures, sorry to say so but he lectures were bad , reading straight from the book
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