Key role of magnetic resonance imaging in the diagnosis of infections around the hip and pelvic girdle mimicking septic arthritis of the hip in children

Infections around the hip and the pelvic girdle mimicking septic hip arthritis are rare conditions in the pediatric population requiring urgent treatment. They are not readily diagnosed because of rarity, resemblance to septic hip, and unclear pathophysiology, which often results in misdiagnosis, delayed diagnosis, and delayed treatment. The aim of this study was to prove the key role of magnetic resonance imaging (MRI) as the first-line modality in making a early definite diagnosis of an uncommon perihip infection in children. We retrospectively reviewed 20 children with a provisional diagnosis of unilateral septic hip who were confirmed finally to have perihip infections and combined with concomitant osteomyeltis using MRI. All patients were treated with intravenous antibiotics with or without abscess aspiration until normalization of clinical symptoms and laboratory tests including serum C-reactive protein and erythrocyte sedimentation rate. All infections healed successfully and the final C-reactive protein was recovered to a mean of 0.37 mg/dl (range 0.01–0.78 mg/dl) without recurrence or complication. Although the MRI is costly and limited in practical application, it was found to be effective as a primary diagnostic tool for an early, accurate diagnosis of infections around the hip and the pelvic girdle in children to correctly guide the decision and the approach for treatment.
Source: Journal of Pediatric Orthopaedics B - Category: Orthopaedics Tags: Hip Source Type: research

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CONCLUSION: When a patient with ONFH has an unexplained elevation of ESR and/or CRP, concomitant septic arthritis of the hip should be suspected. PMID: 31687776 [PubMed - as supplied by publisher]
Source: Surgical Technology International - Category: Surgery Tags: Surg Technol Int Source Type: research
ero A Abstract Facet joint septic arthritis is a rare cause of spinal infection in children with only four cases reported. The transmission pathway is believed to be haematogenous in 72% of cases. The authors present the case of a 13-year-old boy hospitalised for acute lumbosciatalgia, limp and fever, with pain upon palpation of the paravertebral muscles, a positive Laségue signal and elevated serum inflammatory markers. The initial lumbar computerised tomography (TC) scan revealed no abnormalities in the interapophyseal joints. After improving on treatment with analgesics and antibiotics, he was readmitted...
Source: Anales del Sistema Sanitario de Navarra - Category: General Medicine Authors: Tags: An Sist Sanit Navar Source Type: research
Conclusions: We found lower sensitivity and specificity and higher false-positive rates for the Rosenfeld criteria in the hip for our geographically distinct population. Using the Rosenfeld criteria, MRIs would have been ordered unnecessarily in half of our series. Because of potential differences in regional microbiology and anatomic-specific factors, general predictive criteria for coexisting PAI based a single geographic region may be less generalizable to cases of hip sepsis in other geographic areas such as the Northeastern United States. Level of Evidence: Level 4—retrospective cohort study.
Source: Journal of Pediatric Orthopaedics - Category: Orthopaedics Tags: Selected Topics Source Type: research
Authors: Esmaeilnejad-Ganji SM, Esmaeilnejad-Ganji SMR Abstract Brucellosis is a common global zoonotic disease, which is responsible for a range of clinical manifestations. Fever, sweating and musculoskeletal pains are observed in most patients. The most frequent complication of brucellosis is osteoarticular involvement, with 10% to 85% of patients affected. The sacroiliac (up to 80%) and spinal joints (up to 54%) are the most common affected sites. Spondylitis and spondylodiscitis are the most frequent complications of brucellar spinal involvement. Peripheral arthritis, osteomyelitis, discitis, bursitis and tenos...
Source: World Journal of Orthopaedics - Category: Orthopaedics Tags: World J Orthop Source Type: research
Authors: Kawashiri SY, Edo Y, Kawakami A Abstract A 53-year-old Japanese man experienced fever/neck pain, and neck magnetic resonance imaging revealed a spinal epidural abscess. The following day, he developed a palpable mass with evident inflammatory signs in the right sternoclavicular joint (SCJ) with severe pain. Ultrasound revealed synovitis with remarkable power Doppler signals in the right SCJ. Blood cultures yielded Streptococcus agalactiae growth. After 12 days, ultrasound showed right distal clavicle bone erosion. His symptoms improved with long-term parenteral antibiotic treatment, but the right SCJ joint...
Source: Internal Medicine - Category: Internal Medicine Tags: Intern Med Source Type: research
Publication date: November 2018Source: Journal of the American College of Radiology, Volume 15, Issue 11, SupplementAuthor(s): Expert Panel on Pediatric Imaging:, Nabile M. Safdar, Cynthia K. Rigsby, Ramesh S. Iyer, Adina L. Alazraki, Sudha A. Anupindi, Dianna M.E. Bardo, Brandon P. Brown, Sherwin S. Chan, Tushar Chandra, Jonathan R. Dillman, Scott R. Dorfman, Matthew D. Garber, H. F. Samuel Lam, Jie C. Nguyen, Alan Siegel, Roger F. Widmann, Boaz KarmazynAbstractImaging plays in important role in the evaluation of the acutely limping child. The decision-making process about initial imaging must consider the level of suspic...
Source: Journal of the American College of Radiology - Category: Radiology Source Type: research
Imaging plays in important role in the evaluation of the acutely limping child. The decision-making process about initial imaging must consider the level of suspicion for infection and whether symptoms can be localized. The appropriateness of specific imaging examinations in the acutely limping child to age 5 years is discussed with attention in each clinical scenario to the role of radiography, ultrasound, nuclear medicine, computed tomography, and magnetic resonance imaging. Common causes of limping such as toddler ’s fracture, septic arthritis, transient synovitis, and osteomyelitis are discussed.
Source: Journal of the American College of Radiology : JACR - Category: Radiology Authors: Tags: Appropriate use criteria Source Type: research
Conclusions: Although FA did not improve microorganism identification, it did aid in the diagnosis of cooccurring osteomyelitis when treating children with septic arthritis, especially in patients with false negative MRI findings for osteomyelitis. We recommend FA at the time of septic hip I&D as its benefits appear to far outweigh its risks. Level of Evidence: Level III—diagnostic study.
Source: Journal of Pediatric Orthopaedics - Category: Orthopaedics Tags: Infection Source Type: research
Background: Prompt open arthrotomy is historically utilized to treat pediatric septic arthritis of the hip, but arthroscopy has been described as a valid alternative to prevent long-term sequelae. Standard hip arthroscopy in adolescents and adults utilizes lateral-based portals, but successful irrigation in infants may necessitate a medial portal due to the smaller joint size. The purpose of this study was to determine the safety of a medial hip portal in children based on its anatomic relation to neurovascular structures. Methods: A retrospective review of children 6 years of age or below with septic hip arthritis wh...
Source: Journal of Pediatric Orthopaedics - Category: Orthopaedics Tags: Infection Source Type: research
Conclusions: This case series of pediatric patients with PVNS of the knee represents the largest single-center cohort in the literature. Although previously considered a disease of young adult patients, PVNS should be considered in pediatric patients with an insidious onset of joint swelling with or without pain. Symptoms may be present for months to years before diagnosis. Patients are frequently misdiagnosed, most commonly with rheumatologic diseases, bleeding disorders, or septic arthritis. MRI with gradient echo sequences is the diagnostic imaging study of choice and arthroscopic synovectomy produces good outcomes wi...
Source: Journal of Pediatric Orthopaedics - Category: Orthopaedics Tags: Selected Topics Source Type: research
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