PEDIATRICSDIAGNOSIS
■ AP and frog-leg lateral radiographs of the pelvis
■ Bloomberg’s sign(widening or blurring of the epiphyseal plate)
■ Klein line(line drawn along the superior border of the femoral neck)
should intersect the femoral head (see Figure 5.20); if not, suspect a SCFE.
■ In subtle cases, MRI may be helpful.
TOXICSYNOVITIS
■ Also known as transient synovitis
■ Thought to be a self-limited, reactive arthritis that follows a viral infection
■ Most commonly involves the hip joint
■ Typical age range: 3–10 years
SYMPTOMS/EXAM
■ Limp
■ Usually well appearing, nontoxic, and afebrile.
DIAGNOSIS
■ Diagnosis of exclusion: It must be differentiated from other causes of
arthritis, the most important of which is septic arthritis.
■ Laboratory evaluation usually shows a normal or minimally elevated WBC
and ESR.
■ Radiographs may show signs of an effusion but are usually normal.
■ In equivocal cases, aspiration of the joint in question (usually by ultra-
sound guidance) is necessary to further evaluate for possibility of septic
arthritis (signs suggestive of septic arthritis include WBC >50,000, Gram-
positive stain, or culture for bacterial organisms).
■ Lyme arthritis should be considered in endemic areas. Diagnosis is usually
made by initial ELISA testing with confirmatory Western blot assay.
FIGURE 5.20. Klein line.
(Reproduced, with permission, from Stead LG, Stead SM, Kaufman MS. First Aid for the
Pediatric Clerkship. New York: McGraw-Hill, 2004:336.)