2018 Volume 34 Issue 1 Pages 23-30
There are many causes of pediatric fever of unknown origin: infectious, autoimmune, oncologic, neurologic, genetic, factitious, and iatrogenic. More common and clinically significant diseases will be reviewed in this article: pyogenic osteomyelitis, sacroiliitis, leukemia, metastatic neuroblastoma, and juvenile idiopathic arthritis (JIA).
Their clinical manifestations or diagnostic images sometimes overlap. The role of radiograph and computed tomography (CT) for the early diagnosis of musculoskeletal diseases is limited. Magnetic resonance imaging (MRI) is the best modality for early detection of abnormalities of bone marrow, adjacent joint and soft tissue. MRI with gadolinium administration is often effective for evaluating the spread and activity of the inflammation. Ultrasound is also a supportive modality for evaluating soft tissue swelling, subperiosteal abscess, joint effusion, and synovial hypervascularity. It must be kept in mind that abnormal intensities of bone marrow can be diffusely recognized in hematopoietic malignancies such as leukemia and metastatic neuroblastoma in contrast to the other musculoskeletal diseases (osteomyelitis, sacroiliitis, JIA).
It is important to diagnose and begin treatment as soon as possible because delayed diagnosis of these musculoskeletal diseases can cause growth disturbance and bone deformity, For this reason, it is essential to identify the best diagnostic approach and the characteristics of their diagnostic images.
