E4661. Overview of a Protocol and Radiological Assessment in the Limping Child
  1. Lucia Chen; Luton and Dunstable Hospital
  2. Preena Patel; Luton and Dunstable Hospital
  3. Minaxi Dattani ; Luton and Dunstable Hospital
Children commonly present with limping, and there is vast differential diagnosis to consider. The clinical history can provide some direction if there is fever or prior history of trauma, but sometimes in a young child this may prove difficult. A protocol-driven pathway to guide appropriate imaging selection is useful for the general radiologist vetting these scans. Also, pertinent timely interpretation is essential for patient management.

Educational Goals / Teaching Points
In this exhibit, a local limping child protocol and the decision-making tree for appropriate imaging modalities will be demonstrated. There will be a straightforward guide for performing focused ultrasound (US) and then interpreting the US and pediatric radiographs. Then, a discussion of when to use CT and MRI for problem solving in some patients. Finally, the radiological findings of the differential diagnoses, the importance of clinical presentation in consideration of the child’s age will be discussed.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Key points will include a clinical approach to the limping child, discussion of relevant imaging modality techniques (plain radiograph [AP and frog leg]), US joint [focused], CT, and MRI) and radiological interpretation of the differential diagnoses, ranging from common to uncommon. These include slipped upper femoral epiphysis, Perthe’s disease, osteoid osteoma, osteomyelitis, and others.

This exhibit will provide the trainee and general radiologist with a systematic approach in imaging decisions for a limping child and the tools for efficient image interpretation to expedite optimal care.