Sound Bite 7 - Hip Effusion (Paeds)

Author: Dr Nick Mani

7yr old child presents to the Emergency Department with limping, left side, with no history of trauma but recent URTIs. Examination is unremarkable apart from tenderness of the hip joint on rotation, able to partially weight bear..

You elect to perform Point-of-Care Ultrasound (POCUS) of the right hip and compare it to the left side: -

Normalogy- Right Hip Joint/Proximal Femoral Bone Long Axis View

(Click the right arrow for annotation. Purple- Soft tissue, Green- Femoral head/proximal femoral shaft cortex. Note that gap on the left of the image is NOT a fracture, but part of the femoral head anatomy)

Pathology- Left Hip Joint/Proximal Femoral Bone Long Axis View (Same Patient)

(Click the right arrow for annotation. Purple- Soft tissue, Green- Femoral head/proximal femoral shaft cortex. There is a clear Effusion present indicating Transient synovitis in the clinical context. Note that gap on the left of the image is NOT a fracture, but part of the femoral head anatomy)

Case Resolution

The child was safely discharged with advice and safetynetting with the diagnosis of left sided irritable hip/transient synovitis with no need for XR, bloods, or referral to orthopaedics unless returns after 48hrs with ongoing and/or worsening of symptoms/fever.