Subperiosteal abscess in pediatric acute osteomyelitis: ultrasound-guided percutaneous aspiration in three cases.

Subperiosteal abscess is a recognized complication of pediatric acute osteomyelitis and has traditionally been managed with surgical drainage. Evidence supporting minimally invasive ultrasound-guided therapeutic alternatives in children remains limited. We report three pediatric cases of acute osteomyelitis complicated by subperiosteal abscesses successfully treated with ultrasound-guided percutaneous aspiration. In all patients, ultrasound demonstrated subperiosteal collections measuring 4-7 mm in thickness, with no evidence of substantial intraosseous abscess on ultrasound or magnetic resonance imaging. Percutaneous aspiration was performed under real-time ultrasound guidance using fine-caliber needles, without indwelling catheter placement. Purulent material was obtained in all cases, with cultures positive for methicillin-sensitive Staphylococcus aureus. All patients showed rapid clinical and laboratory improvement within 24-48 h, without procedure-related complications, recurrence during follow-up, or subsequent need for surgical drainage. These cases illustrate the feasibility and potential clinical value of ultrasound-guided percutaneous aspiration as a minimally invasive therapeutic option in carefully selected pediatric patients with isolated subperiosteal abscesses.