Department of Radiology, Walter Reed National Military Medical Center, USA
Research Article
Sub-periosteal Fluid Misdiagnosed on MRI as Abscess. Potential to Miss Non-Accidental Trauma.
Author(s): Jonathan Zember*, Rebecca Rohrer, Tanya Hinds, L. Kaleb Friend, Narendra Shet and Eglal Shalaby Rana
Purpose: The literature is confusing when it comes to defining/differentiating periosteal reaction from periostitis,
Sub-Periosteal New Bone Formation (SPNBF), and calcifying sub-periosteal hemorrhage. Furthermore, sub-periosteal
fluid, readily seen on MRI, can be pus from osteomyelitis as well as hemorrhage from trauma. However,
MRI is often obtained to evaluate for osteomyelitis, thus potentially leading to a confirmation bias where
sub-periosteal fluid is attributed to infection. This is particularly concerning in cases of Non Accidental Trauma
(NAT), where the history may be vague. In addition, trauma can produce elevated inflammatory markers, further
clouding the picture. The purpose of this study is to report our experience with MRI and x-ray in patients with
sub-periosteal hemorrhage, all of whom were ultimately diagnosed with NAT.
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