ISHip2016Final

Case 4 A 5 year old boy has had the gradual onset of progressively worsening right hip, right groin, and right knee pain over the past 2 months. His X-ray is shown below. He is treated nonoperatively and his symptoms eventually resolve. What is the most likely diagnosis?

Legg-Calve-Perthes disease

Case 2 A 6 year-old girl has a 2 day history of fever up to 104 degrees F and left hip and thigh pain. She refuses to walk. Blood tests show elevations of her white blood cell count (14,000/mm3), CRP (31 mg/dL), and ESR (52 mm/hr). An MRI scan of the right hip reveals synovial enhancement and a joint effusion and no change in bone marrow signal intensity. What is the most likely diagnosis?

Septic arthritis

Case 3 An obese 12 year old girl has had the gradual onset of progressively worsening left hip, left groin, and left knee pain over the past 2 months. Her X-ray is shown below. What is the most likely diagnosis?

Slipped capital femoral epiphysis

Case 1 A 9-year-old boy presents with a 3 day history of right hip and thigh pain. His pain is worse with weight bearing and movement at the right hip joint. He had an upper respiratory infection about 10 days ago but his respiratory symptoms have resolved. He has had a low grade fever up to 99.8 degrees Fahrenheit and walks with a limp. Physical examination reveals that the range of motion of his right hip is limited due to pain. Blood tests show a normal white blood cell count, normal CRP (C reactive protein), and normal ESR (erythrocyte sedimentation rate). An MRI scan of the right hip reveals synovial enhancement and a joint effusion and no alteration of bone marrow signal intensity. What is the most likely diagnosis?

Transient synovitis

Case 5 A 13 year-old boy has been having right hip and thigh pain with fever for the past two days. He is limping. Blood tests reveal elevation of his white blood cell count, ESR, and CRP levels. An MRI scan shows alteration of the bone marrow signal intensity in the proximal metaphysis of the femur. What is the most likely diagnosis?

Acute osteomyelitis