Just had a patient like this myself. In my experience, 'sympathetic
effusions' are relatively common, and there is some old data to support
this (Espinoza et al. Medicine 1974;53:295-305.) If the patient has
marked limitation in range of motion, I think aspiration is the best
option (by an orthopedist in my practice). A combination of a marrow
scan with technetium sulfur colloid and a technetium bone scan have
fairly good diagnostic accuracy in children in which you have a lower
suspicion (Rao et al. J Pediatr 1985:107:685-688). I know of one small
study in which sed rates in this population had a sensitivity of about
80% of cases of bone or joint infection. (Syrogiannopoulos et al.
Pediatrics 1986;78:1090-1096). Great case Jay!
Jay Fisher MD
Las Vegas NV
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