Book contents
- Frontmatter
- Contents
- List of contributors
- Preface
- Acknowledgments
- Section 1 Brain, head, and neck
- Section 2 Spine
- Section 3 Thorax
- Section 4 Cardiovascular
- Section 5 Abdomen
- Section 6 Pelvis
- Section 7 Musculoskeletal
- Section 8 Pediatrics
- Case 89 Thymus simulating mediastinal hematoma
- Case 90 Foreign body aspiration
- Case 91 Idiopathic ileocolic intussusception
- Case 92 Ligamentous laxity and intestinal malrotation in the infant
- Case 93 Hypertrophic pyloric stenosis and pylorospasm
- Case 94 Retropharyngeal pseudothickening
- Case 95 Cranial sutures simulating fractures
- Case 96 Systematic review of elbow injuries
- Case 97 Pelvic pseudofractures: normal physeal lines
- Case 98 Hip pain in children
- Case 99 Common pitfalls in pediatric fractures: ones not to miss
- Case 100 Non-accidental trauma: neuroimaging
- Case 101 Non-accidental trauma: skeletal injuries
- Index
- References
Case 98 - Hip pain in children
from Section 8 - Pediatrics
Published online by Cambridge University Press: 05 March 2013
- Frontmatter
- Contents
- List of contributors
- Preface
- Acknowledgments
- Section 1 Brain, head, and neck
- Section 2 Spine
- Section 3 Thorax
- Section 4 Cardiovascular
- Section 5 Abdomen
- Section 6 Pelvis
- Section 7 Musculoskeletal
- Section 8 Pediatrics
- Case 89 Thymus simulating mediastinal hematoma
- Case 90 Foreign body aspiration
- Case 91 Idiopathic ileocolic intussusception
- Case 92 Ligamentous laxity and intestinal malrotation in the infant
- Case 93 Hypertrophic pyloric stenosis and pylorospasm
- Case 94 Retropharyngeal pseudothickening
- Case 95 Cranial sutures simulating fractures
- Case 96 Systematic review of elbow injuries
- Case 97 Pelvic pseudofractures: normal physeal lines
- Case 98 Hip pain in children
- Case 99 Common pitfalls in pediatric fractures: ones not to miss
- Case 100 Non-accidental trauma: neuroimaging
- Case 101 Non-accidental trauma: skeletal injuries
- Index
- References
Summary
Imaging description
Hip pain in a young child can be due to toxic or transient synovitis, which is a benign entity that will resolve spontaneously with minimal to no treatment, or due to septic arthritis, which is a serious condition that may require emergency surgery to prevent rapid total joint destruction.
The initial evaluation of a limping child with hip pain typically involves radiography of the pelvis and hips. The best indicator of hip effusion is widening of the joint space, but obliteration of para-articular fat pads may also occur [1]. Joint space widening can appear as increased distance between the ossified proximal femoral metaphysis and the radiographic teardrop when compared to the non-affected contralateral hip joint (Figure 98.1A). With joint inflammation there is para-articular soft tissue edema which obliterates the adjacent fat pads including the obturator and gluteus minimus fat pads, with the obturator fat pad being the more important of the two [1].
Ultrasound is more sensitive than radiography for joint effusions. For evaluation of the hip, the patient lies supine with the hip in extension and slight abduction. The transducer is oriented anteriorly along the axis of the femoral neck. Hip effusions are seen as fluid displacing the joint capsule away from the echogenic cortex of the femoral neck (Figure 98.1B). In subtle cases, a difference in joint distention of greater than or equal to 2mm between the symptomatic and asymptomatic hip has been reported as significant [2]. A normal ultrasound excludes septic arthritis.
- Type
- Chapter
- Information
- Pearls and Pitfalls in Emergency RadiologyVariants and Other Difficult Diagnoses, pp. 358 - 359Publisher: Cambridge University PressPrint publication year: 2013