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Traumatic effusion
1%
18/2176
Toxic synovitis
2%
54/2176
Acute rheumatic fever
12/2176
Juvenille rheumatoid arthritis (JRA)
0%
10/2176
Septic arthritis
95%
2067/2176
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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.
4.2
(22)
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