A 6-year-old boy is brought to the physician by his mother because of a 2-week history of fever and pain in his right thigh that is causing him to limp. She thinks he may have hurt himself during soccer practice. He has no history of rash or joint pain. His immunizations are up-to-date. The patient appears well. He is at the 40th percentile for height and 45th percentile for weight. His temperature is 38.2°C (100.8°F). Examination shows swelling, tenderness, warmth, and mild erythema over the right upper thigh; range of motion is limited by pain . His leukocyte count is 12,300/mm3 and erythrocyte sedimentation rate is 40 mm/h. An intravenous radiotracer that localizes to areas of increased osteoblastic activity is administered, and several images are obtained to find areas with atypical activity. Abnormally increased uptake of the radiotracer is most likely to be seen in which of the following areas?

Question

A 6-year-old boy is brought to the physician by his mother because of a 2-week history of fever and pain in his right thigh that is causing him to limp. She thinks he may have hurt himself during soccer practice. He has no history of rash or joint pain. His immunizations are up-to-date. The patient appears well. He is at the 40th percentile for height and 45th percentile for weight. His temperature is 38.2°C (100.8°F). Examination shows swelling, tenderness, warmth, and mild erythema over the right upper thigh; range of motion is limited by pain . His leukocyte count is 12,300/mm3 and erythrocyte sedimentation rate is 40 mm/h. An intravenous radiotracer that localizes to areas of increased osteoblastic activity is administered, and several images are obtained to find areas with atypical activity.  Abnormally increased uptake of the radiotracer is most likely to be seen in which of the following areas?

Quizplus · Accepted Answer

Eductional Objective: Hematogenous osteomyelitis occurs most commonly in children.  It usually affects the metaphysis of long bones due to the presence of slow-flowing sinusoids that are conducive to bacterial seeding.  Fever and refusal to bear weight are common manifestations in young children who are unable to localize the pain

A 6-Year-Old Boy Is Brought to the Physician by His