Distal Tibial Osteomyelitis in a Pediatric Patient: A Radiological-Oriented Case Report

Osteomyelitis is a serious pediatric bone infection, often hematogenous in origin and primarily caused by Staphylococcus aureus. We present the case of a 12-year-old girl with persistent left ankle pain misdiagnosed initially as a sprain. Imaging played a crucial role in diagnosis: ultrasound revealed soft tissue edema, CT scan showed metaphyseal changes suggestive of chronic osteomyelitis, and MRI confirmed a medullary abscess with physeal involvement. The patient received empirical IV antibiotic therapy (ceftriaxone and clindamycin) and underwent surgical debridement. Her clinical course was favorable with complete resolution. This case highlights the importance of radiological staging in pediatric osteomyelitis diagnosis. MRI proved the most sensitive tool for assessing bone marrow edema and soft tissue extension. In low-resource settings, a stepwise imaging approach, guided by clinical context, enables accurate diagnosis. The radiologist’s active role in interdisciplinary decision-making was pivotal for timely treatment, preventing chronic complications and long-term sequelae.