Subperiosteal abscess

Last revised by Dr Shervin Sharifkashani on 04 Apr 2022

Subperiosteal abscesses refer to the subperiosteal spread of infection characterized by purulent encapsulated fluid collections within the subperiosteal space.

Subperiosteal abscesses are more often seen in children than in adults 1,2.

Subperiosteal abscesses have been associated with the following conditions 1-4:

  • osteomyelitis
  • panton-Valentine leucocidin (PVL) gene positive staphylococcal infections
  • direct trauma or surgery

Clinical symptoms are those of osteomyelitis and include pain, focal tenderness and fever as well as elevated inflammatory markers.

Complications include 1,5:

Subperiosteal abscesses are collections of pus in the subperiosteal space located between the periosteum and the cortex with the vertex of both structures at the perichondrial junction 2-5

Subperiosteal abscesses can be seen on ultrasound by demonstration of a low or mixed echogenic fluid collection that separates the echogenic cortex and periosteum 2-4.

CT will demonstrate an abnormal fluid collection of low attenuation within the subperiosteal space 3.

Similar to other types of abscess a subperiosteal abscess might display a penumbra sign, that is a hyperintense rim on native T1 that enhances after contrast administration 1

Sometimes there might be fat globules within the subperiosteal abscess. The adjacent bone marrow might appear heterogeneous with areas of diminished contrast enhancement 4

  • T1
    • abscess cavity: low to intermediate signal intensity
    • periosteum: low signal intensity
  • T2/T2FS/T2m Dixon-w
    • abscess cavity: high signal intensity
    • periosteum: low signal intensity
  • T1 C+ (Gd)
    • abscess cavity: low signal intensity/no enhancement
    • periosteum: avid enhancement

The radiologist report should include a description of the following features:

  • form, location and size of the fluid collection
  • relation to the fasciae
  • relation to tendons and joints
  • relation to local nerves and vessels

A subperiosteal abscess is a significant negative prognostic finding that usually predicts surgical management in addition to intravenous antibiotics 1-3.

The pathogenesis of subperiosteal abscess formation has been significantly influenced by the work of the Spanish surgeon Josep Trueta in 1959 2,6.

A differential of a subperiosteal abscess includes 3

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Cases and figures

  • Case 1: femur
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  • Case 2: femur
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  • Case 3: with Brodie abscess
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  • Case 4: orbital subperiosteal abscess
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