Related Experiment Videos
[Limp as a presenting symptom of psoas muscle inflammation]
Insights
Psoas muscle inflammation in children is rare and mimics septic hip joint issues. Early diagnosis using physical exams and imaging like ultrasound is crucial for prompt treatment.
Area of Science:
- Pediatric Rheumatology
- Pediatric Infectious Diseases
- Pediatric Orthopedics
Background:
- Psoas muscle inflammation is an uncommon condition in children.
- Symptoms often overlap with more common pediatric conditions like septic hip joint or osteomyelitis, complicating initial diagnosis.
Observation:
- Two pediatric cases (a boy and a girl, both 3.5 years old) presented with fever and limp.
- One child developed an acute abdomen with a retrocecal periappendicular abscess. The other presented with lower quadrant abdominal pain and a confirmed left psoas muscle abscess via ultrasound.
Findings:
- Initial clinical and laboratory findings were consistent with either septic hip joint or osteomyelitis in both cases.
- Diagnostic imaging, including ultrasound, was essential in identifying the psoas muscle abscess in one patient.
Implications:
- Psoas muscle inflammation should be considered in the differential diagnosis for children presenting with a limp.
- Prompt diagnosis through thorough physical examination (including rectal exam) and advanced imaging (ultrasound, CT) can prevent complications and guide appropriate management.
Abstract:
Inflammatory irritation of the psoas muscle in children is rare. The initial diagnosis may be difficult because of the similarity between the symptoms of psoas muscle inflammation and septic hip joint. We present a boy and a girl, both 3.5 years old, with psoas muscle inflammation, whose initial clinical and laboratory findings could be explained by either septic hip joint or osteomyelitis. Both presented with fever and limp. 1 developed an acute abdomen within 3 days and at operation a retrocecal periappendicular abscess was found. In the other, left lower quadrant, abdominal pain developed 4 days following admission and ultrasonic findings indicated a left psoas muscle abscess. We suggest that psoas muscle inflammation should be added to the differential diagnosis of limp in children. Early correct diagnosis can be established by proper physical examination, including rectal examination, and with the aid of diagnostic tools such as ultrasound, computerized tomography or both.