imaging guide from a case series The toddler refusing to weight-bear: a revised

ABSTRACTBackground: The previously mobile child who refuses towalk or weight-bear is a common presentation to theaccident and emergency department, for which there area number of causes. One uncommon cause is discitis, aninflammatory process of the intervertebral disc, which iseasily diagnosed with spinal magnetic resonance imaging(MRI). A case series of three patients is presented of non-weight-bearing children in whom there was a delay inmaking the diagnosis of lumbosacral discitis. Nonepresented with back pain, spinal symptoms or abnormalneurological findings, and a full range of movement ofboth hips was found.Methods: All patients underwent conventional radio-graphy and ultrasound, but diagnoses were made onspinal MRI, with two patients undergoing bone scinti-graphy before this.Results: The mean delay was 15.6 days (range 13–20)from presentation at the hospital to MRI. All threepatients made a good clinical recovery with intravenousantibiotics.Conclusion: These cases are presented in order toheighten the awareness of this disease entity and itsimaging findings, and suggest new guidelines for theappropriate radiological investigations in this clinicalsetting.The previously mobile child who refuses to walk orweight-bear is a common presentation to theaccident and emergency department, for whichthere are a number of causes. The majority of thesechildren will have a transient hip synovitis(‘‘irritable hip’’), joint effusion or long bonefractures, which are easily detected using conven-tional radiography and ultrasound.