Limits...
Avascular necrosis (AVN) of femoral heads bilaterally

USU Teaching File MUTF - MedPix

View Article: MedPix Image - MedPix Case

Affiliation: Uniformed Services University

ABSTRACT

Diagnosis: Avascular necrosis (AVN) of femoral heads bilaterally

History: Patient with history of SLE and corticosteroid use presents with L hip/groin that is exacerbated by activity and gradually worsening over several months but more so over last 2 weeks; denies red/hot/swollen L hip, trauma, recent increases in activity level, pain worse at night, recent illness, fevers/ chills/night sweats, new sexual contacts, or vesicular rash.

Findings: 1. AP and lateral radiographs show a C-shaped area of sclerosis 2. T1W coronal MR image - shows focal area of low signal intensity in the R femoral head consistent with edema; also shows focal area of high signal intensity in the L femoral head surrounded by low signal intensity margin consistent with central fat and peripheral circumferential edema of the head and extension of the edema to the meta-diaphysis; additionally, there is evidence of a focal depression of the L femoral head and irregular L femoral epiphysis. 3. FSE T2W with fat-sat coronal MR image – shows high signal intensity of edema in the R femoral head; also shows high signal intensity of edema surrounding the low signal intensity fat of the L femoral head with extension to the L femoral diaphysis 4. FSE proton density with fat-sat sagittal MR image - no collapse evident

Ddx: Nearly pathognomonic for AVN

Exam: Vital signs stable, well nourished, well developed, and no acute distress; exam remarkable for local tenderness to palpation at L hip; mildly reduced range of motion (ROM) in L hip; mild pain with passive ROM; moderate pain with active ROM; no erythema, edema, or swelling; no weakness or sensorimotor deficit; no rash. CBC and BMP were normal, +ANA, + APA, ESR 72.

No MeSH data available.


Coronal T1W MR image of the hips shows focal area of low signal intensity in the right femoral head consistent with edema and low-signal-intensity foci of edema and high-signal-intensity foci of fat in the left femoral head with low-signal-intensity margin that correlates with the sclerosis on the radiographs. In addition, in the left femur, low-signal-intensity edema extends into the metadiaphysis.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=MPX2557&req=5

MPX2557_synpic17083: Coronal T1W MR image of the hips shows focal area of low signal intensity in the right femoral head consistent with edema and low-signal-intensity foci of edema and high-signal-intensity foci of fat in the left femoral head with low-signal-intensity margin that correlates with the sclerosis on the radiographs. In addition, in the left femur, low-signal-intensity edema extends into the metadiaphysis.


Avascular necrosis (AVN) of femoral heads bilaterally

USU Teaching File MUTF - MedPix

Coronal T1W MR image of the hips shows focal area of low signal intensity in the right femoral head consistent with edema and low-signal-intensity foci of edema and high-signal-intensity foci of fat in the left femoral head with low-signal-intensity margin that correlates with the sclerosis on the radiographs. In addition, in the left femur, low-signal-intensity edema extends into the metadiaphysis.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=MPX2557&req=5

MPX2557_synpic17083: Coronal T1W MR image of the hips shows focal area of low signal intensity in the right femoral head consistent with edema and low-signal-intensity foci of edema and high-signal-intensity foci of fat in the left femoral head with low-signal-intensity margin that correlates with the sclerosis on the radiographs. In addition, in the left femur, low-signal-intensity edema extends into the metadiaphysis.

View Article: MedPix Image - MedPix Case

Affiliation: Uniformed Services University

ABSTRACT

Diagnosis: Avascular necrosis (AVN) of femoral heads bilaterally

History: Patient with history of SLE and corticosteroid use presents with L hip/groin that is exacerbated by activity and gradually worsening over several months but more so over last 2 weeks; denies red/hot/swollen L hip, trauma, recent increases in activity level, pain worse at night, recent illness, fevers/ chills/night sweats, new sexual contacts, or vesicular rash.

Findings: 1. AP and lateral radiographs show a C-shaped area of sclerosis 2. T1W coronal MR image - shows focal area of low signal intensity in the R femoral head consistent with edema; also shows focal area of high signal intensity in the L femoral head surrounded by low signal intensity margin consistent with central fat and peripheral circumferential edema of the head and extension of the edema to the meta-diaphysis; additionally, there is evidence of a focal depression of the L femoral head and irregular L femoral epiphysis. 3. FSE T2W with fat-sat coronal MR image – shows high signal intensity of edema in the R femoral head; also shows high signal intensity of edema surrounding the low signal intensity fat of the L femoral head with extension to the L femoral diaphysis 4. FSE proton density with fat-sat sagittal MR image - no collapse evident

Ddx: Nearly pathognomonic for AVN

Exam: Vital signs stable, well nourished, well developed, and no acute distress; exam remarkable for local tenderness to palpation at L hip; mildly reduced range of motion (ROM) in L hip; mild pain with passive ROM; moderate pain with active ROM; no erythema, edema, or swelling; no weakness or sensorimotor deficit; no rash. CBC and BMP were normal, +ANA, + APA, ESR 72.

No MeSH data available.