Various investigators have had differing results in differentiating septic arthritis from transient synovitis of the hip when using US in combination with laboratory and clinical data [57,61]. A false-negative US is uncommon and could occur when sonography is performed within 24 hours of onset of symptoms [62]. It is important to be aware that there may be other etiologies to a hip effusion, including fractures, osteonecrosis, and juvenile idiopathic arthritis. Acutely Limping Child Up To Age 5 3-Phase Bone Scan Pelvis and Lower Extremity Bone scan was found to have only 70% sensitivity, as compared to MRI, in a series of 33 patients in detecting source of infection in children presented with acute hip pain who did not have septic hip [40]. CT Pelvis CT has decreased sensitivity in the detection of bone marrow pathology and decreased soft-tissue contrast compared to MRI [63-65]. CT with IV contrast could be considered in children with contraindications to MRI [66]. MRI Pelvis MRI has high sensitivity and specificity for musculoskeletal infection, such as septic arthritis, osteomyelitis, and pyomyositis [67]. MRI detected osteomyelitis in about half of children with clinically suspected septic arthritis [56], and septic arthritis was found to be associated with osteomyelitis in MRI in about 70% of patients. Some also have soft-tissue abscesses [67]. For this reason, some advocate using MRI in the initial evaluation of suspected septic arthritis of the hips. In children with signs of infection and acute hip pain with no evidence of septic arthritis, MRI was shown to have better sensitivity than bone scan in detection of the source of infection [40,41]. In addition, osteomyelitis of the pelvis is commonly (28%) associated with soft-tissue abscesses [68], which are easily detected by MRI. Some advocate performing MRI of the pelvis even in children with known septic arthritis because of the possibility of associated osteomyelitis and soft-tissue abscess [69].
Acutely Limping Child Up To Age 5 PCAs. Various investigators have had differing results in differentiating septic arthritis from transient synovitis of the hip when using US in combination with laboratory and clinical data [57,61]. A false-negative US is uncommon and could occur when sonography is performed within 24 hours of onset of symptoms [62]. It is important to be aware that there may be other etiologies to a hip effusion, including fractures, osteonecrosis, and juvenile idiopathic arthritis. Acutely Limping Child Up To Age 5 3-Phase Bone Scan Pelvis and Lower Extremity Bone scan was found to have only 70% sensitivity, as compared to MRI, in a series of 33 patients in detecting source of infection in children presented with acute hip pain who did not have septic hip [40]. CT Pelvis CT has decreased sensitivity in the detection of bone marrow pathology and decreased soft-tissue contrast compared to MRI [63-65]. CT with IV contrast could be considered in children with contraindications to MRI [66]. MRI Pelvis MRI has high sensitivity and specificity for musculoskeletal infection, such as septic arthritis, osteomyelitis, and pyomyositis [67]. MRI detected osteomyelitis in about half of children with clinically suspected septic arthritis [56], and septic arthritis was found to be associated with osteomyelitis in MRI in about 70% of patients. Some also have soft-tissue abscesses [67]. For this reason, some advocate using MRI in the initial evaluation of suspected septic arthritis of the hips. In children with signs of infection and acute hip pain with no evidence of septic arthritis, MRI was shown to have better sensitivity than bone scan in detection of the source of infection [40,41]. In addition, osteomyelitis of the pelvis is commonly (28%) associated with soft-tissue abscesses [68], which are easily detected by MRI. Some advocate performing MRI of the pelvis even in children with known septic arthritis because of the possibility of associated osteomyelitis and soft-tissue abscess [69].