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Septische Arthritis und Coxitis fugax

Septic arthritis and transient synovitis of the hip

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Zusammenfassung

Klinisches/methodisches Problem

Die Unterscheidung zwischen Coxitis fugax und septischer Arthritis des Hüftgelenks kann herausfordernd sein, ist aber sehr wichtig, denn eine zu spät diagnostizierte septische Arthritis kann zu Sepsis und schweren Gelenkschäden führen. Zur korrekten Diagnose und Einschätzung des Komplikationsrisikos bedarf es der richtigen Kombination und Interpretation von Klinik, Laborchemie und Bildgebung.

Radiologische Standardverfahren

Der Ultraschall der Hüfte ist leicht zu erlernen und hat eine hohe Sensitivität für einen Gelenkerguss. Die Magnetresonanztomographie (MRT) dient in erster Linie dem Ausschluss von Begleitinfektionen (Osteomyelitis, Pyomyositis) sowie anderer Differenzialdiagnosen bei klinisch inkonklusiven Befunden oder Beschwerdepersistenz. Die Röntgenaufnahme ist bei septischer Arthritis meist unauffällig.

Empfehlung für die Praxis

Routinemäßiger Einsatz des Ultraschalls bei nichttraumatischen kindlichen Hüftschmerzen. Großzügige Indikationsstellung zur MRT bei klinisch inkonklusiven Befunden oder erhöhten Entzündungsparametern. Je nach Situation ggf. MRT mit wenigen Sequenzen zur Vermeidung einer Sedierung, in erster Linie flüssigkeitssensitive Ödemsuchsequenzen (fettgesättigte T2, Turbo Inversion Recovery Magnitude [TIRM], Short-Tau Inversion Recovery [STIR]), bei Auffälligkeiten ggf. ergänzt um eine T1-Sequenz.

Abstract

Clinical/methodical issue

Differentiating between septic arthritis and transient synovitis can be challenging but is very important as a late diagnosis of septic arthritis can lead to sepsis and joint damage. For correct diagnosis and prediction of complications, the right combination of physical examination, laboratory and radiological studies is needed.

Standard radiological methods

Hip ultrasound is easy to learn and has a high sensitivity for joint effusion. Faster diagnosis and therapy are possible due to increasing use of ultrasound. Magnetic resonance imaging (MRI) is primarily used to rule out co-infections (osteomyelitis, pyomyositis) and differential diagnoses. X‑ray is typically nonremarkable in septic arthritis.

Practical recommendations

Routine use of ultrasound in nontraumatic pediatric hip pain. Generous use of MRI in case of elevated inflammatory markers or inconclusive clinical findings. Using only few sequences may be appropriate to avoid sedation, primarily fluid sensitive sequences (fat-saturated T2, TIRM, STIR), in case of positive findings, accompanied by T1-weighted images.

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Authors and Affiliations

  1. Klinik für Radiologie und Nuklearmedizin, Universitätsmedizin Mannheim, Theodor-Kutzer-Ufer 1–3, 68167, Mannheim, Deutschland

    S. Appelhaus, S. O. Schoenberg &  M. Weis

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  1. S. Appelhaus
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  2. S. O. Schoenberg
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  3. M. Weis
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Correspondence to M. Weis.

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Interessenkonflikt

S. Appelhaus, S.O. Schoenberg und M. Weis geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Appelhaus, S., Schoenberg, S.O. & Weis, M. Septische Arthritis und Coxitis fugax. Radiologie 63, 729–735 (2023). https://doi.org/10.1007/s00117-023-01179-8

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