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When acute osteomyelitis is suspected, ultrasound at the point of maximum tenderness will localise periosteal edema. Guided needle biopsy will relieve the pressure and culture of the pus allows the choice of the best antibiotic. Further bone destruction is almost always prevented.

Soft Tissues

Localized swelling in the soft tissues is usually explained by clinical examination. Ultrasonography can be very helpful in defining the extent and stage of the infection in pyomyositis and in guiding biopsy and aspiration (see chapter on Tropical Pyomyositis). Pyomyositis in the abdominal muscles may be mistaken clinically for an underlying pelvic or abdominal abscess or mass; anywhere in the soft tissues, ultrasonography can be helpful in preventing premature incision before pus has formed.

Guinea Worm Infection (Dracunculiasis). Subcutaneous abscesses occur in the soft tissues, almost anywhere on the body. The worms can be located by ultrasonography, but are seldom identifiable by this means alone. There are no other worms of this length in the soft tissues which are demonstrable by ultrasonography.

Loiasis. Death of the filaria may cause abscesses or granulomas, with fibrosis in the soft tissue. Most remnants of filaria are too small to be recognized with ultrasound (when calcified they may be seen with soft tissue radiographs). High definition ultrasound can demonstrate the worms in onchocerciasis and assess the result of treatment (see chapter on Filariasis).

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