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Primary obturator externus pyomyositis in a child presenting as hip pain: a case report
Abhishek Kumar1, David Anderson
1Department of Orthopaedics, Woodend Hospital, Aberdeen, United Kingdom. drabhi.kp@gmail.com
Insights
Pediatric hip pain can mimic septic arthritis. This case highlights isolated obturator externus muscle abscess, emphasizing diagnostic challenges and the importance of advanced imaging for rare hip conditions.
Area of Science:
- Pediatric Orthopedics
- Pediatric Infectious Diseases
- Pediatric Radiology
Background:
- Hip pain in children presents a diagnostic challenge, with common differentials including septic arthritis, Perthes disease, and slipped capital femoral epiphysis.
- Pyomyositis, particularly rare hip muscle abscesses, can mimic septic arthritis due to indolent presentation and nonspecific laboratory findings.
Observation:
- This report details an 11-year-old child with an isolated obturator externus muscle abscess.
- The presentation was similar to septic arthritis of the hip, complicating diagnosis.
Findings:
- Magnetic resonance (MR) imaging is crucial for diagnosing hip muscle abscesses, identifying early muscular changes.
- Laboratory investigations are often nonspecific, underscoring the reliance on advanced imaging.
Implications:
- Early and accurate diagnosis of rare hip conditions like obturator externus abscess is vital for effective management.
- Prompt antibiotic therapy and potential surgical drainage are key treatment components for favorable outcomes in pediatric hip abscesses.
Abstract:
Hip pain in children often poses a diagnostic dilemma. Septic arthritis, Perthes disease, and slipped capital femoral epiphysis are among the most important causes. Pyomyositis involving muscles around the hip can present with similar features as septic arthritis and are difficult to diagnose because of their rarity and indolent presentation. Obturator internus and iliopsoas muscle abscess have been most commonly reported, with only 1 such report on isolated obturator externus muscle abscess. Routine laboratory investigations are nonspecific, and the diagnosis rests on imaging modalities. Magnetic resonance scan is the most useful investigation in the diagnosis and can pick up early changes in the muscle. Treatment involves appropriate antibiotic therapy with or without drainage. Most cases resolve completely. We report here a case of isolated obturator externus muscle abscess in an 11-year-old child illustrating the similarities with septic arthritis of hip and problems encountered during diagnosis and management.
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