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Based on the image and the clinical presentation — a young boy with persistent right knee pain, visible swelling/effusion, normal range of motion and gait, and a history of multiple falls — the top 3 differential diagnoses (DDx) would include:
1. Intra-articular Loose Body (Osteochondritis Dissecans or Post-Traumatic)
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Why: History of trauma (multiple falls), chronic swelling with preserved motion and function.
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Osteochondritis dissecans (OCD) is common in adolescents and may cause joint effusion and intermittent pain, often without restricted range of motion early on.
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Imaging (X-ray/MRI) would help confirm.
2. Joint Effusion from Post-Traumatic Hemarthrosis (e.g., Patellar or Meniscal Injury)
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Why: Effusion following repetitive trauma, even if motion is preserved.
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A meniscal tear (especially lateral in kids) can cause mechanical irritation and effusion without locking or instability early on.
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A patellar contusion/fracture could also be considered if there's persistent localized pain and swelling.
3. Juvenile Idiopathic Arthritis (JIA) – Pauciarticular Type
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Why: Persistent joint swelling with normal function and no systemic symptoms.
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Although trauma is present, JIA can often be misattributed to injury in early phases.
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Monoarthritis of a large joint (e.g., knee) is a typical early sign.
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ANA testing and monitoring for uveitis may be indicated.
Next steps:
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Obtain knee X-rays to assess for fractures, OCD, or bony fragments.
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If symptoms persist, consider MRI to evaluate soft tissues and cartilage.
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Screen for systemic signs or lab tests (CBC, ESR, CRP, ANA) if inflammatory causes are suspected.
Would you like a comparison table or imaging pointers for distinguishing these?
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