Keywords:
Inflammation, Infection, Developmental disease, Diagnostic procedure, Ultrasound, Plain radiographic studies, MR, Musculoskeletal joint, Musculoskeletal bone
Authors:
S. Peixoto1, E. Bandeira2, L. Lobo2, J. Fonseca-Santos2; 1Lisboa/PT, 2Lisbon/PT
DOI:
10.26044/essr2019/P-0142
Conclusion
Limp in children is not uncommon and results from many different diseases arising from the hip joint itself or referred from other territories.
Clinical history and physical examination are usually complemented by imaging.
With the exception of infants being evaluated for developmental hip dysplasia,
pediatric patients with suspected hip pathology are generally first imaged with AP and frog-leg lateral views of the pelvis to rule out any bony injury.
Ultrasound helps to differentiate which hips require early intervention and guides needle aspiration of joint fluid if indicated.
MRI is highly sensitive and specific and frequently reveals unexpected clinically important causes of hip pain in children with negative or equivocal radiographs.
Computed tomography and bone scintigraphy are useful in looking for distant or multifocal disease,
but have a limited role in this age group because of the risks associated with radiation exposure.
It is important for the radiologist to be familiar with the spectrum of diseases causing limp or hip pain in children,
its imaging appearances and most effective imaging modalities in each context,
in order to avoid delayed diagnosis and proper treatment.
Remember that septic arthritis,
osteomyelitis and SUFE require the most urgent management to prevent significant morbidity.