This week’s case highlights a patient with non-verbal autism presenting with difficulty walking. Most learners would start with x-rays but agree that if unremarkable, would likely progress to getting an ultrasound as well. Learners discussed the utility of getting labs prior to imaging results. Given the patient is autistic, there was discussion about holding on labs to potentially prevent a challenging IV stick if imaging ultimately shows an osseous abnormality. However, given the inconsistent and ambiguous presentation, other learners felt that early labs to rule out osteomyelitis or septic arthritis would be more efficient and necessary. Learners highlighted the utility of a POCUS as a third, potentially faster, option to assess for hip effusion or fracture.

Patient with a Kocher Score 2 which imparts a 40% probability of septic arthritis; intermediate probability and may require radiology or orthopedics consultation for hip aspiration. Regarding antibiotics, consensus was that if patient was not ill-appearing, that antibiotics could be held for potential ortho aspiration.

Patient admitted for sedated MRI of bilateral hips and pain control. MRI showed bilateral hip effusions and mild synovitis. No arthrocentesis was done. Inflammatory markers were trended and downtrended. Patient was ultimately discharged home with a diagnosis of transient synovitis.

The information in these cases has been changed to protect patient identity and confidentiality. The images are only provided for educational purposes and members agree not to download them, share them, or otherwise use them for any other purpose.