Differential Diagnosis for Right Hip Discomfort in Children

Single Most Likely Diagnosis

• Transient Synovitis: This is the most common cause of acute hip pain in children, often presenting with hip discomfort that improves with rest. It is an inflammatory condition of the synovial tissue surrounding the hip joint, typically seen in children between 3 to 10 years old.

Other Likely Diagnoses

• Legg-Calve-Perthes Disease: A condition characterized by avascular necrosis of the femoral head, leading to hip pain and discomfort, especially with weight-bearing activities. It is more common in boys between 4 to 8 years old.
• Slipped Capital Femoral Epiphysis (SCFE): A condition where the femoral head slips off the femoral neck through the growth plate, causing hip pain that can be exacerbated by weight-bearing and improved with rest. It is more common in obese adolescents.
• Septic Arthritis: Although less common than transient synovitis, septic arthritis is a significant concern due to its potential for rapid joint destruction. It presents with severe hip pain, fever, and limited mobility, and is a medical emergency.

Do Not Miss Diagnoses

• Malignancy (e.g., Osteosarcoma, Ewing's Sarcoma): Although rare, bone cancers can present with hip pain and must be considered to avoid delayed diagnosis and treatment.
• Infectious Diseases (e.g., Osteomyelitis): Infections of the bone can cause severe pain and have serious consequences if not promptly treated.
• Juvenile Idiopathic Arthritis (JIA): An autoimmune condition that can cause hip pain among other symptoms, and requires early diagnosis for effective management.

Rare Diagnoses

• Gaucher's Disease: A genetic disorder that can lead to avascular necrosis of the femoral head, among other systemic manifestations.
• Sickle Cell Disease with Avascular Necrosis: Patients with sickle cell disease are at risk of avascular necrosis of the femoral head, which can cause hip pain.
• Fibromyalgia: Although more common in adults, fibromyalgia can occur in children and cause widespread musculoskeletal pain, including hip discomfort.

Each of these diagnoses has distinct features and requires a thorough clinical evaluation, including history, physical examination, and often, imaging studies and laboratory tests to confirm the diagnosis and guide appropriate treatment.