|Patient: 47 year old male|
|History: 47 yr. old man with chronic left hip pain.|
| Findings: |
Plain films show mottled increased radiopacity of either femoral head, more prominent on the left, and a slightly "out of round" appearance of the left femoral articular cortex. There is a subtle subchondral radiolucent "crescent sign" paralleling the articular cortex of the left femoral head and a focal area of collapse along the superolateral articular margin.
|Diagnosis: Bilateral avascular necrosis of the femoral heads|
| Discussion: |
Disrupted blood supply to all or part of the femoral head is the mechanism of insult. Avascular necrosis typically presents in the 20-50 age range as chronic hip pain, although pain may radiate to the lower thigh/knee area. Many cases are apparently spontaneous, although recognized predisposing factors include:
trauma (AVN may complicate 10% of non-displaced and up to 30% of displaced femoral neck fxs),
corticosteroid use (accounting for 5-25% atraumatic cases)
Sickle cell anemia and other coagulopathies
Imaging findings are classified as stages 1-4 (Ficat and Arlet). Plain film X-ray findings are not sensitive to early disease and are normal in the 1-2 stages. Plain films are typically not positive until stage 3,when loss of the spherical shape of the femoral head occurs. MR evaluation is the method of choice and can detect stage 1 disease. A "double line sign" of serpiginous high signal along the periphery of the affected area outlined by an outer hypointense line is usually best seen on T2 images, but can be seen on the PDfatsat.
| References: |
DIAGNOSTIC IMAGING ed.1 Stoller, Triman, Bredella, et.al. Amirsys pub. 2004
| Comments: |
No comments posted.
| Additional Details:|
Case Number: 3173677Last Updated: 08-16-2006 The reader is fully responsible for confirming the accuracy of this content.
The reader is fully responsible for confirming the accuracy of this content.