An 8-year-old boy presented to the emergency department with swelling and pain of his left knee and calf for approximately 1 week. His examination was significant for moderate knee effusion and swelling of the posterior calf with erythema and warmth of the affected areas. An ultrasound obtained at an outside hospital showed a large heterogeneous mass in the gastrocnemius, and a magnetic resonance imaging revealed a large, heterogeneous, rim-enhancing collection in the medial head of the left gastrocnemius muscle with surrounding myositis involving the gastrocnemius muscle. The child was taken to the operating room by the orthopedic team for drainage and irrigation of the knee effusion and of the collection in the gastrocnemius. The diagnosis of Lyme pseudothrombophlebitis was made through Lyme serology testing of aspirated fluid. He improved after this drainage but required a prolonged antibiotic course.
A 10-year-old girl with a 2-week history of atraumatic back pain presented to the emergency department with difficulty ambulating and a history of 2 episodes of urinary incontinence in the past week. Her examination was significant for pain with movement, tenderness to palpation in the lower thoracic spine, and no neurological deficits. In this case, the child was found to have a Schmorl node at T8 in the superior aspect of the vertebral body. Schmorl nodes are protrusions of the cartilage of the intervertebral disc through the vertebral body endplate and into the adjacent that is more commonly reported in the adult population. In this child, radiographic findings were normal, with no evidence of the Schmorl node. The diagnosis was made by magnetic resonance imaging. The child's symptoms significantly resolved with ibuprofen anti-inflammatory therapy. In children with atraumatic back pain lasting greater than 2 weeks with a sudden increase in severity and associated with a neurological deficit, advanced imaging is strongly recommended.
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