Limping in toddlers: pelvic abscess presenting with transient synovitis picture
1Department of Pediatrics, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Insights
Limping in toddlers can signal serious pelvic issues, not just common hip joint problems. Early, thorough examination and imaging are crucial for diagnosing conditions like pelvic abscess, ensuring prompt treatment.
Area of Science:
- Pediatric Orthopedics
- Pediatric Infectious Diseases
- Pediatric Radiology
Background:
- Limping is a frequent pediatric concern, often linked to lower extremity or hip joint conditions.
- Differential diagnoses for limping include trauma, inflammation, infection, and malignancy.
Observation:
- A 20-month-old boy presented with limping and fever, initially suspected as transient synovitis.
- Persistent limping, inguinal tenderness, and edema led to advanced imaging.
Findings:
- Magnetic resonance imaging (MRI) revealed a pelvic abscess, not evident on initial X-rays or blood work.
- The patient recovered after ultrasound-guided abscess drainage and antibiotics.
Implications:
- Pelvic pathology, such as abscess, should be considered in toddlers presenting with limping.
- Comprehensive physical exams focusing on hip-adjacent structures and judicious use of imaging are vital for accurate diagnosis.
Background:
Limping is a common presenting pediatric complaint, caused by conditions originating in the lower extremities as well as in anatomical areas surrounding the hip joint. Pathologic processes presenting with limping include trauma, inflammation, infection, and malignancy.
Objectives:
In this report, we present a case of pelvic abscess presenting with limping in a toddler. We review common conditions presenting with limping in this age group, and discuss laboratory and radiographic evaluation of limping in toddlers.
Case Report:
A 20-month-old previously healthy boy presented for evaluation of limping and history of fever. The physical examination was suggestive of transient synovitis. Radiological evaluation revealed normal hip X-ray study, a normal complete blood count, and a moderately increased erythrocyte sedimentation rate. Due to the persistence of limping, tenderness over the inguinal area and subsequent development of edema over the inguinal area, magnetic resonance images of the hip and pelvis were obtained, which revealed a pelvic abscess. The patient improved after ultrasound-guided drainage of the abscess and a course of intravenous antibiotics.
Conclusion:
Although transient synovitis is the most common pathology that causes limping in toddlers, limping can also be a presentation of pelvic pathology. Thus, in this age group, a detailed physical examination of the patient with special emphasis on structures adjacent to the hip joint is extremely important. Laboratory evaluation and additional imaging help confirm the suspected diagnosis.
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