ReviewImaging of the limping child
Introduction
Limping is a common and non-specific symptom in the pediatric patient. The differential diagnosis can range from minor contusions to malignancies, making diagnosis challenging. Often, a minor or inappropriate trauma can reveal a pre-existent condition. The radiologist should consider common and uncommon causes of limping according to incidence of inflammatory-infectious, malformative or neoplastic diseases in the different age groups. Main causes of limping related to patient's age are summarized in Table 1 and Fig. 1.
First line imaging modalities [Ultrasound (US) and X Ray] are often diagnostic and essential for a proper selection of those patients requiring further imaging [1]. Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) examinations are performed in selected cases, as their use is limited by the need of sedation/anesthesia and the use of ionizing radiation, respectively.
Section snippets
Imaging evaluation
The imaging evaluation of the limping child varies depending on the patient's age, presence of signs of infection, any specific localization of pain, and history of trauma [2].
Even if hip pathologies represent the main cause of limping in the pediatric patient the radiologist has to keep in mind all possible differential diagnosis.
A systematic approach is essential to focus on the more appropriate multimodality imaging evaluation and narrow the differential diagnosis. Many studies in the
Pearls and pitfalls
Numerous anatomical variants and developmental changes are normal findings in the immature skeleton and may represent diagnostic challenges. Comparative evaluation of the contralateral side must be reserved to doubtful cases and should always be performed after radiographic examination of the affected side; a routinely radiographic examination of both sides represents an inappropiate dose exposition. Main pitfalls encountered in the pediatric lower limb are briefly described.
Transient synovitis
Transient synovitis of the hip is a self-limiting acute inflammatory disorder of unknown etiology, even though most authors attribute inflammation to a recent viral infection, and is the most frequent cause of limping in children. It generally occurs in 4–8 year-old children with a male to female ratio of 2:1 and is bilateral in about 5% of cases [24].
Patients present with limping and pain localized to the groin region, anterior thigh or medial knee. The hip is usually held in an antalgic
Conclusions
Limping represents a diagnostic challenge in the pediatric patient. A systematic imaging approach based on patient’s age, history of trauma, and symptoms of infection, is essential to narrow the spectrum of differential diagnosis.
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