Heterogeneous Knee Effusions on Point-of-Care Ultrasound in a Toddler Diagnosed With Juvenile Idiopathic Arthritis

Abstract

Point-of-care musculoskeletal ultrasound can provide information about joint effusions and the quality of the effusion. This case report describes the findings of a previously healthy pediatric patient with acute onset of knee swelling and abnormal gait. After point-of-care ultrasound demonstrated bilateral knee effusions with complex, heterogeneous material, subsequent workup revealed a diagnosis of juvenile idiopathic arthritis (JIA). We review the ultrasound technique, sonographic findings, and literature regarding point-of-care ultrasound for knee effusions and JIA.

Point‐of‐Care Ultrasound‐Guided Drainage of Joint Effusions in the Pediatric Emergency Setting: A Case Series

“…We are also not aware of any prior published reports of POCUS‐guided aspiration of the knee in children by a PEM physician. In the case report cited in the introduction, 7 the joint effusion contained material with heterogenous echotexture rather than the homogenous effusions that we show here. There, the knees were not aspirated for culture, likely because the presentation was bilateral, which is unusual for septic arthritis.…”

“…Hip joint effusions identified on point‐of‐care ultrasound (POCUS) in the PED have been described by several authors, 3–6 and PED POCUS evaluation of other large joint effusions is rarely discussed in the literature 7 . Given the rarity of pediatric large‐joint effusions, particularly elbow and shoulder effusions, POCUS can provide invaluable guidance to practitioners inexperienced in the drainage of large‐joint effusions.…”

“…POCUS has been reported in a single case as a method for diagnosing septic shoulder in an adult male 15 . A case report exists of a toddler with bilateral knee effusions seen on POCUS as the presenting sign of juvenile idiopathic arthritis 7 . Case reports of POCUS‐guided identification of elbow effusions in adults have recently been published, 9,16 …”

“…15 A case report exists of a toddler with bilateral knee effusions seen on POCUS as the presenting sign of juvenile idiopathic arthritis. 7 Case reports of POCUS-guided identification of elbow effusions in adults have recently been published, 9,16 With approval of our institutional review board (IRB), we collected a case series of five patients who presented to the PED from August to December 2020 with effusions of hip, shoulder, knee, or elbow identified and aspirated under POCUS. IRB authorization does not require individual patient consent in a case series.…”

Agreement With Pediatric Suprapatellar Bursa Effusion Assessments by Point-of-Care Ultrasound After Remote Training

“…One case report describes POCUS diagnosis of a heterogenous knee effusion in a toddler with an eventual diagnosis of idiopathic juvenile arthritis. 10 Pediatric rheumatology musculoskeletal ultrasound has emerged as an important tool to guide treatment decisions with scoring systems developed for pediatric knee joint evaluations. 11,12 We are not aware of literature that compares POCUS to RADUS for the diagnosis of pediatric suprapatellar bursa (SPB) effusions.…”