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Joint effusion in children with an irritable hip: US diagnosis and aspiration
J K Zawin1, F A Hoffer, F F Rand
1Department of Radiology, Children's Hospital, Boston, MA 02115-5747.
Insights
Ultrasonography (US) helps diagnose septic arthritis in children. Normal US scans effectively rule out septic arthritis, while effusion on US guides aspiration for definitive diagnosis.
Area of Science:
- Pediatric Orthopedics
- Diagnostic Imaging
- Infectious Diseases
Background:
- Irritable hip in children can indicate serious conditions like septic arthritis.
- Accurate and timely diagnosis is crucial for effective treatment and preventing complications.
Purpose of the Study:
- To evaluate the utility of ultrasonography (US) in diagnosing septic arthritis in children presenting with an irritable hip.
- To assess the role of US-guided aspiration in confirming the diagnosis and guiding treatment.
Main Methods:
- Ninety-six children with irritable hip underwent clinical evaluation, laboratory tests, radiography, and US.
- US-guided aspiration was performed on children with effusion.
- Analysis of synovial fluid and clinical outcomes were used to confirm diagnoses.
Main Results:
- Normal US scans excluded septic arthritis, though osteomyelitis remained a possibility in three cases.
- Fifty-six children had effusion on US; 31 underwent US-guided aspiration.
- Septic arthritis was diagnosed in 15 of 31 aspirated patients, confirmed by aspirate analysis and surgical drainage.
- Erythrocyte sedimentation rate and synovial fluid WBC count were significantly higher in septic arthritis than toxic synovitis.
Conclusions:
- US is valuable in excluding septic arthritis but cannot rule out osteomyelitis.
- US-guided aspiration aids in selecting patients with septic arthritis for surgical drainage, improving diagnostic accuracy and procedure efficiency.
Abstract:
Ninety-six children with an irritable hip possibly representing septic arthritis underwent clinical and laboratory evaluation, radiography, and ultrasonography (US). Forty had normal US scans; none were later shown to have septic arthritis, although three had osteomyelitis. Fifty-six children had effusion at US. Thirty-one of these underwent US-guided aspiration, two unsuccessfully. On the basis of results of aspirate analysis, 15 of these 31 patients underwent surgical drainage, and septic arthritis was diagnosed in all 15. The mean peripheral white blood cell (WBC) count was not significantly higher in patients with septic arthritis (n = 21) than in patients with toxic synovitis (n = 24) (P = .44). However, the erythrocyte sedimentation rate and synovial fluid WBC count were significantly greater in those with septic arthritis than in those with toxic synovitis (P = .002 and P < .0001, respectively). Clinical evaluation, radiographs, and sonograms together determined the need for US-guided aspiration. US-guided aspiration allowed selection of only those with septic arthritis for operative drainage and shortened that procedure. Negative sonograms allow exclusion of septic arthritis but not osteomyelitis.