Hip pain in childhood

Adolescent Hip Pain Due to Iliopsoas Abscess

Hip pain in children and adolescents poses a diagnostic challenge due to various underlying causes, ranging from benign to severe conditions. Presented here is the case of an otherwise healthy 14-year-old boy who arrived at the emergency department with a two-day history of left hip pain, limping, fever, anorexia, and vomiting. Upon physical examination, tenderness was noted upon palpation of the left sacroiliac joint and with mobilization of the left lower limb. Elevated inflammatory markers raised suspicion of an osteoarticular infection. Despite initially normal imaging, subsequent MRI revealed an iliopsoas abscess, later confirmed by blood cultures positive for Staphylococcus aureus. A conservative management with antibiotics was selected due to the infeasibility of percutaneous or surgical drainage, leading to clinical improvement. This case highlights the efficacy of non-surgical approaches in selected situations and underscores the importance of a thorough evaluation, early suspicion of infection, appropriate imaging, and tailored antimicrobial therapy in managing hip pain in pediatric patients.

Value of MR arthrography for evaluation of children and adolescents with clinically suspected intraarticular cause of hip pain

PURPOSE

To evaluate the distribution of intra- and extraarticular MRI findings in children and adolescents with clinically suspected intraarticular cause of hip pain in order to assess the need for additional intraarticular contrast administration.

MATERIAL AND METHODS

Database was searched over a period of 34 months retrospectively for consecutive hip MR arthrography in young patients (8-17 years) with suspected intraarticular cause of hip or groin pain. Exclusion criteria were prior hip surgery, follow-up examination due to known intraarticular pathology, incomplete examination, qualitatively non-diagnostic examinations, and missing informed consent. Reports of fellowship-trained MSK radiologists were searched for intraarticular versus extraarticular findings explaining hip or groin pain.

RESULTS

Seventy patients (68% female; median age: 14.5 years; range:10.8-16.9 years) were analyzed. No reason for pain was found in 30 (42.9%) hips, extraarticular reasons in 20 (28.6%) cases, intraarticular in 14 (20.0%), and both (intra- and extraarticular) in 6 (8.6%) hips. Most common extraarticular reasons were apophysitis (14.3%), other bony stress reactions (12.9%), intramuscular edema (7%), tendinitis (5.7%), and trochanteric bursitis (4.3%). Labral pathology was the most common intraarticular finding (overall:34.3%; partial tear:15.7%, complete tear:15.7%), most frequent at the anterosuperior position (81.8%). Cartilage defects (1.4%), intraarticular neoplasia (1.4%), and tear of the femoral head ligament (2.8%) were rarely found. Synovitis and loose bodies were not observed. Cam-(37.1%) and pincer-configurations (47.1%) were common while hip dysplasia was rare (5.7%).

CONCLUSION

MRI in children and adolescents with hip pain should be done primarily without intraarticular contrast administration since most cases show an extraarticular pain reason or no diagnosis detectable with MRI.