MRI in Suspected Acute Septic Arthritis of the Hip Joint in Children

Soo-Sung Park; Soo-Ho Lee; Gyeong-Bo Sim

doi:10.5371/hp.2012.24.4.295

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Park, Lee, and Sim: MRI in Suspected Acute Septic Arthritis of the Hip Joint in Children

Original Article

Hip & Pelvis

Hip & Pelvis 2012; 24(4): 295-301.

Published online: 31 December 2012

DOI: https://doi.org/10.5371/hp.2012.24.4.295

MRI in Suspected Acute Septic Arthritis of the Hip Joint in Children

Soo-Sung Park, MD, PhD, Soo-Ho Lee, MD, PhD, Gyeong-Bo Sim, MD

Department of Orthopaedic Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea.

Address reprint request to Gyeong-Bo Sim, MD. Department of Orthopaedic Surgery, Asan Medical Center, Ulsan University College of Medicine, Asanbyeongwon-gil 86, Songpa-gu, Seoul 138-736, Korea. TEL: +82-2-3010-0834, FAX: +82-2-488-7877, alert79@hanmail.net

Received 21 August 2012 Revised 23 November 2012 Accepted 26 November 2012

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study is to assess the usefulness of magnetic resonance imaging (MRI) in diagnosis, planning of treatment methods for suspected acute septic arthritis in children, and evaluation of the clinical results of the operations with the help of magnetic resonance imaging as a diagnostic modality.

Materials and Methods

Between March 2003 and May 2007, 20 patients suspected of having acute septic arthritis of the hip underwent MRI. The mean age of the patients was 3 years and 5 months (range: 10 days-14 years). The average follow-up was 2 years and 2 months (range: 1 year-3 years 6 months). Assessment of MRI findings and final results with recurrence of the infection and post-infectious radiographic sequelae was performed retrospectively.

Results

Among the 20 cases, 17 cases(85%) showed joint effusion. Among these 17 cases, accompanying signal changes were observed in the meta-epiphyseal region in seven cases, and accompanying signal changes were observed in surrounding soft tissue in three cases. Accompanying abscess formation was observed in one case. The remaining three cases(15%), which had no joint effusion, showed an intramuscular abscess pocket around the joint, which mimicked septic arthritis. At final follow up, two cases showed unsatisfactory results, with limited joint motion and radiographic sequelae.

Conclusion

In children who are suspected of having acute septic arthritis of the hip, MRI can provide useful information about the location and extent of infection and even the differential diagnosis of acute septic arthritis. MRI was considered to be a useful method for diagnosis of suspected acute septic arthritis in children.

Keywords: Children, Septic hip arthritis, MRI

Figures and Tables

Fig. 1

9-year-old boy with acute septic arthritis in Rt hip joint. (A) Coronal T1-weighted spin-echo MR image Siemens (IR/TE,450/11), (B) T2-weighted spin-echo MR image (3000/99), (C) fat-suppressed gadolinium-enhanced T1-weighed spin-echo MR image (735/14), demonstrate effusion in Rt hip joint and diffuse enhancement in Rt hip joint synovium.

Fig. 2

6-month-old girl with abscess in adductor muscle. (A) Coronal T1-weighted spin-echo MR image (TR/TE, 420/12), (B) T2-weighted spin-echo MR image (3000/99), (C) fat-suppressed gadolinium-enhanced T1-weighted spin-echo MR image (616/12), demonstrate abscess pocket in adductor muscle and myositis involving adductor muscle and obturator muscle.

Fig. 3

22-day-old girl with abscess in psoas muscle. (A) Low signal intensity mass-like lesion is seen in Coronal T1-weighted spin-echo MR image (TR/TE, 450/11), (B) T2-weighted spin-echo MR image (3000/99) shows high signal intensity fliud signal in the mass-like lesion, (C) that lesion have inhomogeneous enhancement in fat-suppressed gadolinium-enhanced T1-weighted spin-echo MR image (735/14).

Fig. 4

(A) There was a residual deformity of right proximal femur and right acetabulum due to sequelae of septic arthritis in both hip antero-posterior, (B) frogleg lateral radiogragh.

Table 1

Diagnostic Data in Twenty Patients with Suspected Septic Hip Arthritis

^*PPh.: peripheral

^†WBC: white blood cell

^‡diff.: differential count

^§BM: bone marrow

^∥S.aureus: Staphylococcus aureus

^¶S.viridan: Streptococci viridian

^**P.aerugin: Pseudomonas aeruginosa

^††Ent.cloaca: Enterobacter cloaca

^‡‡Strept pn: Streptococcus pneumoniae

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