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The toddler refusing to weight-bear: a revised imaging guide from a case series
O J Arthurs1, A C Gomez, P Heinz
1Department of Radiology, Addenbrooke's Hospital, Cambridge, UK.
Insights
A rare cause of a child refusing to walk is discitis, an infection of the intervertebral disc. Early diagnosis with spinal magnetic resonance imaging (MRI) is crucial for prompt treatment and recovery.
Area of Science:
- Pediatric Emergency Medicine
- Pediatric Radiology
- Pediatric Infectious Diseases
Background:
- Refusal to walk or weight-bear in previously mobile children is a common emergency department presentation.
- Lumbosacral discitis is an uncommon but treatable cause of this symptom.
- Diagnosis can be delayed due to the absence of typical symptoms like back pain or neurological deficits.
Observation:
- A case series of three children presenting with non-weight-bearing gait is described.
- None of the children had back pain, spinal symptoms, or abnormal neurological findings.
- Full range of motion in both hips was noted in all patients.
Findings:
- Conventional radiography and ultrasound were performed, but spinal magnetic resonance imaging (MRI) confirmed the diagnosis of discitis.
- There was a mean diagnostic delay of 15.6 days from hospital presentation to MRI.
- All patients recovered well with intravenous antibiotics.
Implications:
- Highlights the importance of considering discitis in children who refuse to bear weight, even without typical symptoms.
- Emphasizes the diagnostic value of spinal MRI for lumbosacral discitis.
- Suggests a need for revised guidelines for radiological investigations in this clinical scenario to reduce diagnostic delays.
Background:
The previously mobile child who refuses to walk or weight-bear is a common presentation to the accident and emergency department, for which there are a number of causes. One uncommon cause is discitis, an inflammatory process of the intervertebral disc, which is easily diagnosed with spinal magnetic resonance imaging (MRI). A case series of three patients is presented of non-weight-bearing children in whom there was a delay in making the diagnosis of lumbosacral discitis. None presented with back pain, spinal symptoms or abnormal neurological findings, and a full range of movement of both hips was found.
Methods:
All patients underwent conventional radiography and ultrasound, but diagnoses were made on spinal MRI, with two patients undergoing bone scintigraphy before this.
Results:
The mean delay was 15.6 days (range 13-20) from presentation at the hospital to MRI. All three patients made a good clinical recovery with intravenous antibiotics.
Conclusion:
These cases are presented in order to heighten the awareness of this disease entity and its imaging findings, and suggest new guidelines for the appropriate radiological investigations in this clinical setting.
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