Transient synovitis of the hip
2 years old male with left hip pain and limping.
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Mild to moderate effusion of the left hip joint with distension of the joint capsule. Minimal right hip joint effusion. No marrow signal abnormality. No soft tissue mass lesion. Bilateral non-specific inguinal lymph nodes.
Features consistent of Transient synovitis of the hip. It is self-limited with unknown mechanism; it might be post-viral and could be preceeded by upper respiratory tract viral infection.
The main differential diagnosis is septic arthritis of the hip. It is critical not to miss early septic arthritis as delayed managment may lead to permanant destruction of the hip joint and early osteoarthritis or permanent deformity.
Marrow signal intensity alterations in the bone marrow of the affected hip joint is the main differentiating point between septic arthritis and transient synovitis. Decreased perfusion of the femoral epiphysis on fat-suppressed post-contrast coronal T1-weighted MRI can also differentiate septic arthritis from transient synovitis
- Lee SK, Suh KJ, Kim YW et-al. Septic arthritis versus transient synovitis at MR imaging: preliminary assessment with signal intensity alterations in bone marrow. Radiology. 1999;211 (2): 459-65. Radiology (full text) - Pubmed citation
- Kwack KS, Cho JH, Lee JH et-al. Septic arthritis versus transient synovitis of the hip: gadolinium-enhanced MRI finding of decreased perfusion at the femoral epiphysis. AJR Am J Roentgenol. 2007;189 (2): 437-45. doi:10.2214/AJR.07.2080 - Pubmed citation