Abstract:OBJECTIVE. The purpose of this study was to identify differences in the MRI findings of septic arthritis and transient synovitis in patients with nontraumatic acute hip pain and hip effusion.MATERIALS AND METHODS. The MRI findings in nine patients with septic arthritis and 11 with transient synovitis were reviewed retrospectively. This study was approved by our institutional review board. The diagnoses were based on findings at physical examination, laboratory studies, and joint aspiration and bacteriologic st… Show more
“…This has been suggested to be a sign of septic arthritis and it has recently been also reported as a sign of epiphyseal osteomyelitis in pre-school age children [32,33].…”
Background K. kingae is a common causative organism in acute osteoarticular infections (OAIs) in children under 4 years of age. Differentiation between K. kingae and Gram-positive cocci (GPC) is of great interest therapeutically. Objective Our aim was to identify early distinguishing MRI features of OAIs. Materials and methods Thirty-one children younger than 4 years of age with OAI underwent MRI at presentation. Of these, 21 were caused by K. kingae and ten by GPC. Bone and soft tissue reaction, epiphyseal cartilage involvement, bone and subperiosteal abscess formation were compared between the two groups. Interobserver agreement was measured. Results Bone reaction was less frequent (P = 0.0066) and soft tissue reaction less severe (P = 0.0087) in the K. kingae group. Epiphysis cartilage abscesses were present only in the K. kingae group (P = 0.0118). No difference was found for bone abscess (P = 0.1411), subperiosteal abscess (P = 1) or joint effusion (P = 0.4414). Interobserver agreement was good for all criteria.Conclusion MRI is useful in differentiating K. kingae from GPC in OAI. Cartilaginous involvement and modest soft tissue and bone reaction suggest K. kingae.
“…This has been suggested to be a sign of septic arthritis and it has recently been also reported as a sign of epiphyseal osteomyelitis in pre-school age children [32,33].…”
Background K. kingae is a common causative organism in acute osteoarticular infections (OAIs) in children under 4 years of age. Differentiation between K. kingae and Gram-positive cocci (GPC) is of great interest therapeutically. Objective Our aim was to identify early distinguishing MRI features of OAIs. Materials and methods Thirty-one children younger than 4 years of age with OAI underwent MRI at presentation. Of these, 21 were caused by K. kingae and ten by GPC. Bone and soft tissue reaction, epiphyseal cartilage involvement, bone and subperiosteal abscess formation were compared between the two groups. Interobserver agreement was measured. Results Bone reaction was less frequent (P = 0.0066) and soft tissue reaction less severe (P = 0.0087) in the K. kingae group. Epiphysis cartilage abscesses were present only in the K. kingae group (P = 0.0118). No difference was found for bone abscess (P = 0.1411), subperiosteal abscess (P = 1) or joint effusion (P = 0.4414). Interobserver agreement was good for all criteria.Conclusion MRI is useful in differentiating K. kingae from GPC in OAI. Cartilaginous involvement and modest soft tissue and bone reaction suggest K. kingae.
“…15 It is also possible to use magnetic nuclear resonance, which is able to detect further details and also the decrease of femoral head perfusion. 16 But it is an exam that requires anesthesia in younger children or sedation, and is not always available, especially in our field. Bone scanning can also be used, with more restricted use, whereas at the beginning of septic arthritis the image appears with a low standardized uptake value due to the decreased blood flow and, afterwards a "hot" standard, due to the result of the vascular response of blood flow increase.…”
O diagnóstico diferencial entre a artrite séptica e a sinovite transitória do quadril não é fácil de ser realizado, pois não há um exame que seja simples, nem satisfatoriamente sensível e específico para diferenciá-las. Sendo assim, é muitas vezes utilizada uma propedêutica armada de exames que demanda maior custo e requer melhor infra-estrutura da instituição de saúde. Perante isso, torna-se evidente a necessidade de uma análise multifatorial dos dados clínicos e laboratoriais envolvidos para a proposição de um fluxograma em que se possa racionalizar exames visando a correta abordagem e evitar a indicação de procedimentos, muitas vezes, desnecessários como a ressonância magnética ou mais invasivos como a artrocentese e a própria drenagem cirúrgica. Realizamos uma ampla revisão da literatura nas bases de dados do Pubmed e Cochrane até maio de 2009 em que foi analisada a importância do exame clínico, dos testes laboratoriais e de imagem para a diferenciação entre as duas afecções. Mediante o cruzamento dos dados foi elaborado um fluxograma para o diagnóstico e conduta na criança e no adolescente, com idade de seis meses a dezoito anos, com sintoma de dor no quadril, na suspeita de quadro inflamatório. Nivel de Evidência III, estudos diagnósticos, investigação de um exame para diagnóstico.
“…In transient synovitis of the hip, a 2-view standard x-ray examination (anterioreposterior and frog-leg lateral views) yields a negative outcome or is only indicative of joint effusion [1,5]. According to some authors [2] gadolinium-enhanced magnetic resonance has proven useful in the differential diagnosis between transient synovitis and septic arthritis because septic arthritis presents a reduced perfusion of the femoral head in gadolinium-enhanced images. However, this sign is not always present.…”
Section: Ultrasound Examinationmentioning
confidence: 99%
“…In 5% of cases the lesion is bilateral and it is sometimes associated with a low-grade fever usually not exceeding 38 C. Diagnosis is essentially by exclusion because imaging is similar to that of other causes of acute hip pain in children. The main differential diagnosis is septic arthritis [2] and juvenile rheumatoid arthritis. Also cases of Lyme arthritis of the hip [3] with clinical and imaging characteristics identical to transient synovitis of the hip are described in the literature.…”
KEYWORDSTransient synovitis; Hip; Hip pain; Ultrasonography.Abstract We describe the ultrasound (US) appearance of transient synovitis. Transient synovitis of the hip typically occurs in 3 to 8-year-old children. The onset is clinically characterized by acute hip pain and limp with limited joint mobility, and the leg is usually held in a position of flexion and external rotation to avoid pain. US image is characterized by joint effusion in the hip joint anterior recess, as described in the literature. Our experience confirms the importance of the technique with which the US examination is performed. In order to obtain the best diagnostic information the hip must be examined with the patient in the supine position and the hip joint in a neutral position (abduction of the hip with extension and slight external rotation) by means of an anterior approach along the long axis of the femoral neck in the parasagittal plane.Sommario Viene descritto l'aspetto ecografico della sinovite transitoria dell'anca. La sinovite transitoria dell'anca colpisce tipicamente i pazienti di età pediatrica, compresa tra 3 ed 8 anni; il suo esordio è clinicamente caratterizzato da un'insorgenza acuta di dolore all'anca e zoppicamento con limitata motilità articolare ed atteggiamento antalgico in flessione ed extra-rotazione. L'aspetto ecografico è caratterizzato da versamento articolare a livello del recesso anteriore dell'anca, come descritto in letteratura. La nostra esperienza conferma l'importanza della tecnica di esecuzione dell'ecografia, infatti per ottenere le migliori informazioni diagnostiche l'anca deve essere esaminata a paziente supino con l'articolazione in posizione indifferente (estensione e lieve extra-rotazione) mediante una scansione anteriore secondo un piano para-sagittale rispetto all'asse lungo del collo del femore. ª
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