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Avascular Necrosis of Hip

Patterson RAP - MedPix

View Article: MedPix Image - MedPix Case

Affiliation: Uniformed Services University

ABSTRACT

Diagnosis: Avascular Necrosis of Hip

History: History (can include gestational age, or age in days, weeks, months): 18 year old male with a 1 year history of pre B-cell acute lymphocytic leukemia currently on chemotherapy protocol that includes treatment with vincristine, methotrexate, prednisone/dexamethasone surges, and 6-MP. Patient complains of recent onset of bilateral hip pain.

Findings: Imaging Findings: Anteroposterior (AP) radiograph of the hips at presentation was normal and showed normal mineralization with no evidence of subluxation, dislocation, fractures, or osteoblastic/osteolytic changes. Magnetic resonance (MR) imaging of both the right and left hips demonstrated subchondral low signal intensity of the femoral head on coronal T1 imaging, best seen on the left, that becomes high signal intensity on a coronal STIR (fat suppressed) image. There was also increased signal intensity of the femoral neck, particularly the lateral margin, on STIR imaging. A subsequent AP hip radiograph 2 months after presentation shows new subchondral fracture lucencies in the right and left femoral heads and mild flattening of the left superior head along with bilateral preserved joint space. A year after presentation, an AP hip radiograph showed an increase in collapse of the left femoral head and bilateral early degenerative change of the hips.

Ddx: Differential Diagnosis for these findings in this case: Avascular necrosis secondary to steroid therapy

Dxhow: Imaging

Exam: Physical Exam and Laboratory: Normal physical exam except for bilateral decreased range of motion of the hips and atalgic gait secondary to hip pain. Laboratory studies showed mild macrocytic anemia and leukopenia.

No MeSH data available.


A subsequent AP hip radiograph 2 months after presentation shows new subchondral fracture lucencies in the right and left femoral heads and mild flattening of the left superior head. The joint spaces are preserved bilaterally
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MPX1722_synpic23306: A subsequent AP hip radiograph 2 months after presentation shows new subchondral fracture lucencies in the right and left femoral heads and mild flattening of the left superior head. The joint spaces are preserved bilaterally


Avascular Necrosis of Hip

Patterson RAP - MedPix

A subsequent AP hip radiograph 2 months after presentation shows new subchondral fracture lucencies in the right and left femoral heads and mild flattening of the left superior head. The joint spaces are preserved bilaterally
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=MPX1722&req=5

MPX1722_synpic23306: A subsequent AP hip radiograph 2 months after presentation shows new subchondral fracture lucencies in the right and left femoral heads and mild flattening of the left superior head. The joint spaces are preserved bilaterally

View Article: MedPix Image - MedPix Case

Affiliation: Uniformed Services University

ABSTRACT

Diagnosis: Avascular Necrosis of Hip

History: History (can include gestational age, or age in days, weeks, months): 18 year old male with a 1 year history of pre B-cell acute lymphocytic leukemia currently on chemotherapy protocol that includes treatment with vincristine, methotrexate, prednisone/dexamethasone surges, and 6-MP. Patient complains of recent onset of bilateral hip pain.

Findings: Imaging Findings: Anteroposterior (AP) radiograph of the hips at presentation was normal and showed normal mineralization with no evidence of subluxation, dislocation, fractures, or osteoblastic/osteolytic changes. Magnetic resonance (MR) imaging of both the right and left hips demonstrated subchondral low signal intensity of the femoral head on coronal T1 imaging, best seen on the left, that becomes high signal intensity on a coronal STIR (fat suppressed) image. There was also increased signal intensity of the femoral neck, particularly the lateral margin, on STIR imaging. A subsequent AP hip radiograph 2 months after presentation shows new subchondral fracture lucencies in the right and left femoral heads and mild flattening of the left superior head along with bilateral preserved joint space. A year after presentation, an AP hip radiograph showed an increase in collapse of the left femoral head and bilateral early degenerative change of the hips.

Ddx: Differential Diagnosis for these findings in this case: Avascular necrosis secondary to steroid therapy

Dxhow: Imaging

Exam: Physical Exam and Laboratory: Normal physical exam except for bilateral decreased range of motion of the hips and atalgic gait secondary to hip pain. Laboratory studies showed mild macrocytic anemia and leukopenia.

No MeSH data available.