E2184. Beneath the Surface: Unraveling the Complexities of Pediatric Subperiosteal Abscess
  1. Max Hao; Stony Brook University Hospital
  2. Maira Riaz; No Affiliation
  3. Katherine Chung; Stony Brook University Hospital
  4. Musa Mufti; Stony Brook University Hospital
Subperiosteal abscess is an infected collection within the subperiosteal space. It is commonly associated with hematogenous osteomyelitis in the pediatric population due to the loosely adherent periosteum to the underlying cortex in the immature bones. Hematogenous osteomyelitis in children primarily affects the highly vascularized metaphysis and metaphyseal-equivalent regions such as the junctions of bone and cartilage in immature flat bones. Infections can reach the subperiosteal space hematogenously through the metaphysis or through direct inoculation due to trauma. It is vital for radiologists to recognize the presence of subperiosteal abscess in the setting of osteomyelitis as it portends worse prognosis and may lead to formation of intraosseous abscess, bone necrosis, septic arthritis, and chronic osteomyelitis. Subperiosteal abscesses will often require surgical drainage. In this educational exhibit, several cases will be presented that are focused on pediatric subperiosteal abscess in the extremities.

Educational Goals / Teaching Points
The goal of this educational exhibit is to provide a case-based review of subperiosteal abscess in the setting of acute hematogenous osteomyelitis. We will first describe the current paradigm for the anatomic basis of hematogenous spread of pediatric osteomyelitis. Then we will review noteworthy features on radiographic, ultrasound, CT, and MRI, and finally discuss prognosis and management of subperiosteal abscesses.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Review the pathophysiology and anatomic basis for the hematogenous osteomyelitis and subperiosteal abscess. Key imaging features of subperiosteal abscess on radiography, sonography, CT, and MRI. Associated complications from subperiosteal abscess including intraosseous and soft tissue abscesses, septic arthritis, osteonecrosis, and chronic osteomyelitis.

As a predominately pediatric pathology, subperiosteal abscess can lead to prolonged infection, significant bone destruction, and life-threatening sepsis if not diagnosed and treated in a timely manner. It is important for radiologists to understand the pathophysiology of subperiosteal abscess developing from osteomyelitis in the pediatric population; and to recognize the specific imaging features of subperiosteal abscess on various imaging modalities in order to make the best diagnosis and recommendations to the referring physicians.