Review Question - QID 2964

This patient most likely has a septic hip based on clinical, radiographic, and laboratory data. Traumatic effusions have less than 5,000 leukocytes, toxic synovitis (5,000-15,000 leuckocytes with <25% PMNs), rheumatic fever (10,000-15,000 leukocytes with 50% PMNs), and JRA (15,000-80,000 leukocytes with 75% PMNs). Synovial fluid analysis for septic arthritis includes >50,000 leukocytes and >75% PMNs. The review article by Sucato et al notes that JRA can be present similarly to a septic joint with a hip effusion with high leukocyte count and >75% PMN's. However, they mention that JRA patients often have gradual onset of symptoms, less pain, usually continue weightbearing activities, and lack constitutional symptoms. Illustration A compares the sonographic findings in a normal hip compared to a hip with an effusion.