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[Septic coxitis in childhood. Differential ultrasound diagnoses]
1Orthopädische Klinik, Fakultät für Klinische Medizin Mannheim, Universität Heidelberg.
Insights
Ultrasound can detect joint capsule distention in pediatric hip conditions, but cannot differentiate septic arthritis from other causes. Prompt diagnostic puncture is crucial for suspected septic arthritis.
Area of Science:
- Pediatric Orthopedics
- Diagnostic Imaging
- Rheumatology
Background:
- Septic arthritis requires prompt diagnosis and treatment to prevent joint damage.
- Ultrasound is a common imaging modality for pediatric hip pain.
- Differentiating septic arthritis from other hip conditions in children can be challenging.
Purpose of the Study:
- To evaluate the diagnostic efficiency of ultrasound in identifying septic arthritis in children.
- To assess ultrasound's ability to differentiate septic arthritis from other pediatric hip pathologies.
Main Methods:
- A total of 259 children with hip pain were examined using ultrasound.
- Standard DEGUM planes were utilized to analyze joint capsule, femoral head surface, and periarticular structures.
- Ultrasound findings were correlated with clinical diagnoses including septic arthritis, transient synovitis, juvenile rheumatoid arthritis, Legg-Calvé-Perthes disease, and slipped capital femoral epiphysis.
Main Results:
- Ultrasound can diagnose capsular distention and joint effusion, signs present in septic arthritis, transient synovitis, juvenile rheumatoid arthritis, and early Legg-Calvé-Perthes disease.
- Capsular distention is a non-specific sign and ultrasound alone cannot distinguish septic arthritis from non-specific arthritis.
- When combined with osseous abnormalities, ultrasound can help differentiate slipped capital femoral epiphysis/Legg-Calvé-Perthes disease from septic/non-specific arthritis.
Conclusions:
- Ultrasound is useful for detecting capsular distention but is not sufficient for differentiating septic arthritis from other pediatric hip conditions.
- Immediate diagnostic puncture under ultrasound guidance is recommended when septic arthritis is suspected.
- Ultrasound plays a role in evaluating pediatric hip pain, but its limitations in differentiating septic arthritis must be recognized.
Abstract:
The efficiency of ultrasound was tested in septic arthritis. A total of 259 children with hip pain, septic arthritis (n = 14), transient synovitis (n = 120), juvenile rheumatoid arthritis (n = 12), Legg-Calvé-Perthes disease (n = 92) and slipped capital femoral epiphysis (n = 21) were examined by ultrasound. By using the standard planes described by the DEGUM, it is possible to analyze the joint capsule, the surface of the femoral head and the periarticular structures. In cases with synovitis or joint effusion, capsular distention can be diagnosed by ultrasound. This distention is typical in septic arthritis, transient synovitis, juvenile rheumatoid arthritis, and in the onset phase of Perthes disease. Because capsular distention and osseous abnormalities in the various diseases are similar differentiation is not possible. Therefore, ultrasound cannot distinguish between septic and non-specific arthritis; capsular distention is a non-specific ultrasound sign. Immediate diagnostic puncture is necessary if septic arthritis is suspected (possible by ultrasound control). In cases with both capsular distention and osseous abnormalities, ultrasound usually allows differentiation between slipped capital femoral epiphysis/Perthes disease and septic/non-specific arthritis.