The aim of this poster is tohighlighthow the Radiology department can assist their Peadiatric surgical and medical colleagues inexcluding sepsis as the cause of an atraumaticlimp in a child.
The objectives to achieve this include:
Reviewing the advantages and disadvantages of different imaging modalities in this setting.
Pictorial review of differing presentations and sitesof sepsismanifesting asa limp.
A brief review of differential diagnosesascause of an atraumatic limp.
A limp is a deviation from normal age appropriate gait pattern and incidence is quoted as1.5-3.6/1000 <14 years.Causes of atraumatic limp in a child range from innocuous pathology such as transient synovitis through to paediatric orthopaedic surgical emergencies such as joint sepsis and slipped upper femoral epiphyses.
Prior to any investigation a thorough history,
including gait assessment and baseline blood investigations,
including CRP and wbc,will ensure best use of the radiology department.
It will help triage patients likely to have self limiting pathology...
Imaging findings OR Procedure Details
Case 1 (Fig. 3 )
Soft tissue infection - Buttock Abscess
2 year old,
non weight bearing on left leg. Recent chickenpox infection became increasingly irritable and febrile.
Reluctant with both active and passive leg movements.
CRP 209 (<5),
wbc 30.1 (4-11)
Diagnosis - Left gluteal abscess with oedema in adjacent muscles and soft tissues.
SIJor hip joint involvement.
Open surgical drainage.
Growth of Beta-Haemolytic Streptococcus.
Treated with Flucloxacillin and Clindamycin.
Case 2 (Fig. 4)
5 year old limping...
Infection can cause a child of any age to present with the symptom of an atraumaticlimp,
the causative problem can be found anywhere from spine to foot.
To reduce unneccessary irradiation and general anaesthesia in paediatric patients diagnostic imaging should be performed following athorough history and clinical examination and with close correlationto inflammatory markers and other laboratory tests.
Imaging is commonly utilised in evaluation of a limping child.
The limp is a symptom,
the diagnostic challenge to establish causality and to ensure prompt diagnosis of...
• Evaluating the child who presents with an acute limp.
Bruce BMJ 2010;341:c4250
• The child with a limp: a symptom and not a diagnosis
Smith et al Arch Dis Child Educ Pract Ed 2012;97:185-193
• Osteomyelitis and beyond.
Pediatr Radiol 2013;43(1): S193-203
• Radiological approach to a child with hip pain.
Jain et al.
Clinical Radiology 69(2013) 1167-1178