Variant 3: Child up to age 5. Acute limp. Nonlocalized symptoms. Concern for infection. Initial imaging. Limping in the presence of one or more of the following clinical and laboratory signs should suggest the possibility of infection: fever, elevated white blood cell count, elevated erythrocyte sedimentation rate, or elevated C-reactive protein. The differential diagnoses in this scenario most commonly include septic arthritis, osteomyelitis, discitis, pyomyositis, Langerhans cell histiocytosis, and tumor (eg, leukemia, osteosarcoma, Ewing sarcoma, and metastatic disease). When there are signs and symptoms suggestive of an infectious process, imaging has a role in substantiating the diagnosis, localizing the site of infection, evaluating for complications that require surgical intervention, and excluding other pathologies that mimic infection. Radiography Lower Extremities Radiographs have low yield in detecting infection when symptoms and signs are not localized [39,40]. US Hips or Lower Extremity A small field of view limits the role of US when symptoms and clinical evaluation cannot localize the site of pathology [14]. Because pain that is due to hip pathology can be referred elsewhere in the lower extremity, such as the thigh, knee, or buttock [15], US of the hip could be considered even when symptoms cannot be well localized. 3-Phase Bone Scan Pelvis and Lower Extremity Bone scan is reported to have a high sensitivity for the diagnosis of osteomyelitis [17]. Advantages of bone scan in the evaluation of infection include whole-body imaging for site localization, with the main disadvantage being the lack of soft-tissue evaluation and anatomic detail, particularly for the detection of small abscesses [16]. Bone scan may be particularly helpful in cases with implanted hardware and postoperative patients already with Acutely Limping Child Up To Age 5 extensive edema and tissue alternations.
Acutely Limping Child Up To Age 5 PCAs. Variant 3: Child up to age 5. Acute limp. Nonlocalized symptoms. Concern for infection. Initial imaging. Limping in the presence of one or more of the following clinical and laboratory signs should suggest the possibility of infection: fever, elevated white blood cell count, elevated erythrocyte sedimentation rate, or elevated C-reactive protein. The differential diagnoses in this scenario most commonly include septic arthritis, osteomyelitis, discitis, pyomyositis, Langerhans cell histiocytosis, and tumor (eg, leukemia, osteosarcoma, Ewing sarcoma, and metastatic disease). When there are signs and symptoms suggestive of an infectious process, imaging has a role in substantiating the diagnosis, localizing the site of infection, evaluating for complications that require surgical intervention, and excluding other pathologies that mimic infection. Radiography Lower Extremities Radiographs have low yield in detecting infection when symptoms and signs are not localized [39,40]. US Hips or Lower Extremity A small field of view limits the role of US when symptoms and clinical evaluation cannot localize the site of pathology [14]. Because pain that is due to hip pathology can be referred elsewhere in the lower extremity, such as the thigh, knee, or buttock [15], US of the hip could be considered even when symptoms cannot be well localized. 3-Phase Bone Scan Pelvis and Lower Extremity Bone scan is reported to have a high sensitivity for the diagnosis of osteomyelitis [17]. Advantages of bone scan in the evaluation of infection include whole-body imaging for site localization, with the main disadvantage being the lack of soft-tissue evaluation and anatomic detail, particularly for the detection of small abscesses [16]. Bone scan may be particularly helpful in cases with implanted hardware and postoperative patients already with Acutely Limping Child Up To Age 5 extensive edema and tissue alternations.