MyPACS.net: Radiology Teaching Files > Case 911237

never visited 23 Y/O MALE WITH BILATERAL HIP PAIN, CATCHING AND CLICKING
Contributed by: John Hunter, Radiologist, University of California, Davis, California, USA.
Patient: 23 year old male
History: 23 y/o male with bilateral hip pain, catching and clicking
Images:[small]larger

Fig. 1: April 04: Plain film

Fig. 2: November 04: pre-op left hip debridement

Fig. 3: December 04: immediate post-op film left hip

Fig. 4: Coronal T1WI/fat sat post IV Gad

Fig. 5: Coronal T1WI/fat sat post IV Gad

Fig. 6: Coronal T1WI/fat sat post IV Gad

Fig. 7: Coronal T1WI/fat sat post IV Gad

Fig. 8: Coronal T1WI/fat sat post IV Gad
Findings: Uncovering of femoral heads bilaterally, femoral neck spurring. MR was not an arthrographic study, but performed with IV contrast. The labrum, cartilage and fluid are enhanced. Post-operative plain films: right greater trochanteric osteotomy to facilitate visualization during debridement of labrum and resection of "dysplastic bump" or femoral neck spur.
Diagnosis: Bilateral dysplasia with labral tears bilaterally.
Discussion: The non-contrast T2 and IR images barely showed the labral abnormalities. The use of IV gad (in this case, they were looking for something like a mass, therefore the contrast) is an example of "indirect arthrography", relying on the IV injection to equilibrate with the joint fluid to enhance any fluid present. This technique usually involves excercise of the joint in question and a delay in imaging to allow diffusion into the joint. While there possibly was some delay in scanning post injection, this was not documented and no excercise was done. The formal MRA with distension of the joint remains the procedure of choice for labral pathology.
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Additional Details:

Case Number: 911237Last Updated: 12-17-2004
Anatomy: Skeletal System   Pathology: Congenital
Modality: Conventional Radiograph, MRExam Date: Access Level: Readable by all users
Keywords: hip dysplasia, labral tearACR: 44.484

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