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Differential Diagnosis for 15-year-old Boy with Left Hip and Groin Pain

Single Most Likely Diagnosis

  • Slipped Capital Femoral Epiphysis (SCFE): This condition is the most likely diagnosis given the patient's age, symptoms, and physical examination findings. The patient's weight is above the 85th percentile, which increases the risk for SCFE. The external rotation of the left hip and shortening of the left lower extremity are classic signs of SCFE. The condition typically presents with hip or groin pain and is more common in obese adolescents.

Other Likely Diagnoses

  • Legg-Calve-Perthes Disease: This condition is a possible diagnosis, given the patient's age and symptoms. It is characterized by avascular necrosis of the femoral head and can present with hip or groin pain, limited range of motion, and shortening of the affected limb.
  • Transient Synovitis: This is a common cause of hip pain in children and adolescents, often presenting with sudden onset of hip pain and limited range of motion. However, the duration of symptoms (two months) and the presence of shortening and external rotation make this diagnosis less likely.
  • Septic Arthritis: Although less likely given the absence of systemic symptoms (e.g., fever, chills), septic arthritis is a possible diagnosis, especially if the patient has a history of recent infection or immune compromise.

Do Not Miss Diagnoses

  • Malignancy (e.g., Osteosarcoma, Ewing's Sarcoma): Although rare, malignancies can present with hip or groin pain and should be considered in the differential diagnosis, especially if the patient has systemic symptoms (e.g., weight loss, fatigue) or a family history of cancer.
  • Infectious Diseases (e.g., Osteomyelitis, Pyomyositis): These conditions can present with hip or groin pain and should be considered, especially if the patient has a history of recent infection, immune compromise, or systemic symptoms.

Rare Diagnoses

  • Femoral Neck Stress Fracture: This is a rare condition in adolescents, but can occur in athletes or individuals with a history of repetitive stress on the hip.
  • Hip Dysplasia: Although more commonly diagnosed in infancy or early childhood, hip dysplasia can present later in life, especially if the condition is mild or the patient has a family history of the condition.

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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