A previously healthy 4-year old boy is brought in by his parents because they noticed that he has been refusing to walk since this afternoon when they came home from work. He had previously been doing well but parents noticed over the past few days he has been complaining of right leg pain without any limitation in his activity until today. He was in school all day but there was no reported trauma. Aside from that, the child has not had any fevers, cough, runny nose, vomiting, diarrhea, abdominal pain or rash.
He is well appearing and cooperative with your exam, as he is well distracted by the ‘Frozen’ video playing on the iPad provided by Child Life. He allows you to palpate and range his right ankle and knee while singing along to ‘Let it go.’ However, as soon as you begin to passively range his right hip, he withdraws his leg in pain and glares at you over the iPad. There are no signs of trauma, erythema, or swelling. The remainder of his exam, including the abdominal and genitourinary exam, are unremarkable.
As you await transport for bilateral hip radiographs, you wheel in your ultrasound machine and perform a targeted hip ultrasound and obtain the following images:
Thank you for playing! Answers and explanations will be posted in a few days.
If you want to see YOUR image included in the next Image of the Month, please email interesting stills and/or clips in addition to a small blurb on the patient to Lorraine Ng at PEMFellowscom@gmail.com.
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