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Juvenile Idiopathic Arthritis

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Here's another patient with hip pain.

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This is a 10-year-old girl with left hip pain.

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I'm not going to show you the radiographs.

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Basically, the radiographs demonstrated

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findings of a left hip effusion, which

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I think is well illustrated here on this

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coronal fluid-sensitive fat-suppressed sequence.

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We're looking at the left hip

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here and the right hip over here.

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What do we notice immediately?

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Well, I immediately notice that there is a

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pretty good-sized effusion on the left side.

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And one word I want to point

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out about hip effusions.

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Hip effusion is probably the single

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most important thing that you should

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be looking for when a child comes in

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with hip pain on a plain radiograph.

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Because hip effusion means that

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there's something wrong with that hip.

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You don't know what's wrong.

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It could be an infection, it could be

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avascular necrosis, it could be something

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like this, but there's something that's

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irritating that area and that joint.

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And the body reacts to any sort of irritation

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by sending fluid and inflammation to it.

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So when you have a joint effusion,

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you don't know what's causing it,

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but you know there's something wrong.

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So that's why the plain

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radiographs are important.

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are really important for you to look

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for subtle changes of hip effusion.

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So once you have it, then you get other

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imaging, ultrasound, MRI, what have you,

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depending on your clinical suspicion.

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So I just want to throw that out there.

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So this patient has a left hip effusion.

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And what do we notice besides the hip effusion?

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Well, there is a geographic area.

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I call it geographic because I feel like

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I can take a marker, like this, and I can go

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like that.

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All the way around, like this, like

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this, and define the area of abnormality.

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So, what's going on over there?

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Well, we know it's edematous, and it's

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geographic, and it has caused a joint effusion.

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What if we gave contrast?

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What does this look like if we give contrast?

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Let us go ahead and bring the

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contrast images over here.

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And there is a little bit of enhancement there.

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Let me convince you that it really does enhance

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by bringing you a pre-contrast image. I'll put

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this back here. A pre-contrast image is here.

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One word of warning is, if you see

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something bright on a post-contrast

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image, how do you know it's actually

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enhancing unless you have a pre-contrast?

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Because it may have been intrinsically

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bright, T1 bright to begin with.

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Always compare your post-contrast

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images with your pre-contrast images.

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And here I think you can be convinced that

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this, in fact, is an area of enhancement.

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It's not just this area that's

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enhancing, but also the synovium.

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is enhancing.

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Well, there is a geographic area.

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I call it geographic because I feel like

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I can take a marker, like this, and I can go

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like that.

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All the way around, like this, like

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this, and define the area of abnormality.

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So, what's going on over there?

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Well, we know it's edematous, and it's

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geographic, and it has caused a joint effusion.

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What if we gave contrast?

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What does this look like if we give contrast?

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Let us go ahead and bring the

1:57

contrast images over here.

2:00

And there is a little bit of enhancement there.

2:03

Let me convince you that it really does enhance

2:05

by bringing you a pre-contrast image. I'll put

2:09

this back here. A pre-contrast image is here.

2:11

One word of warning is, if you see

2:13

something bright on a post-contrast

2:15

image, how do you know it's actually

2:17

enhancing unless you have a pre-contrast?

2:19

Because it may have been intrinsically

2:21

bright, T1 bright to begin with.

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Always compare your post-contrast

2:24

images with your pre-contrast images.

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And here I think you can be convinced that

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this, in fact, is an area of enhancement.

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It's not just this area that's

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enhancing, but also the synovium.

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is enhancing.

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So where you had joint effusion

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before, the synovium is rotated.

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So you have synovial enhancement, joint

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effusion, and this funny geographic area of

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abnormal signal sort of in the mid femoral head.

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So this is a condition called

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idiopathic chondrolysis.

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Idiopathic chondrolysis, as the name would

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imply, is unknown why it happens, but there

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actually is a very high association with

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juvenile idiopathic chondrolysis.

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arthritis, or JIA, juvenile

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idiopathic arthritis.

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In fact, the several cases that I

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have seen, eventually those patients

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have been diagnosed with JIA.

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So when you see a pattern like this, first

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recognize it for the condition that it is,

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which is idiopathic chondrolysis, and you

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want to mention, hey, could this be JIA?

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If so, maybe the rheumatologist should

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see this patient, maybe some arthritis

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markers should be run, as a blood test.

Report

Faculty

Mahesh Thapa, MD, MEd, FAAP

Division Chief of Musculoskeletal Imaging, and Director of Diagnostic Imaging Professor

Seattle Children's & University of Washington

Tags

Pediatrics

Non-infectious Inflammatory

Musculoskeletal (MSK)

MRI

Infectious

Idiopathic

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