What’s the Diagnosis – Case 121
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What’s the Diagnosis – Case 121
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What’s the Diagnosis – Case 121
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What’s the Diagnosis – Case 121
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What’s the Diagnosis – Case 121
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What’s the Diagnosis – Case 121
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What’s the Diagnosis – Case 121
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What’s the Diagnosis – Case 121
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What’s the Diagnosis – Case 121
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What’s the Diagnosis – Case 121
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What’s the Diagnosis – Case 121
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What’s the Diagnosis – Case 121
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What’s the Diagnosis – Case 121
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What’s the Diagnosis – Case 121
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What’s the Diagnosis – Case 121
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Findings The radiographs demonstrate radiolucency/osteopenia of the bones about the left hip as compared to the right. The MRI shows striking edema of the proximal left femur with very subtle, subchondral, linear, irregular signal of the left femoral head.
What’s the Diagnosis – Case 121
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What’s the Diagnosis – Case 121
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What’s the Diagnosis – Case 121
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What’s the Diagnosis – Case 121
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What’s the Diagnosis – Case 121
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What’s the Diagnosis – Case 121
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What’s the Diagnosis – Case 121
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What’s the Diagnosis – Case 121
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What’s the Diagnosis – Case 121
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What’s the Diagnosis – Case 121
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What’s the Diagnosis – Case 121
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What’s the Diagnosis – Case 121
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What’s the Diagnosis – Case 121
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What’s the Diagnosis – Case 121
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What’s the Diagnosis – Case 121
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Diagnosis: Subchondral Fracture The very subtle area of irregularity of the femoral head represents a subchondral fracture. There is typically as shown here a marked amount of edema even in the setting of the very subtle deformity. Patients typically have marked pain and difficulty with activity. It is my belief as well as many others that the concept previously described as transient osteoporosis of the hip in fact represents these very subtle subchondral fractures. In years past, we were limited by resolution to see these very subtle fractures but given current techniques and equipment these subtle fractures can now be seen. Interestingly, in this case the patient had an outside MRI that was read as necrosis. Areas of AVN do not have a striking degree of edema unless they have collapsed or are collapsing. In that situation, again there is subchondral fracturing that is precipitating the edema. In a subchondral fracture or AVN with collapse, the marked edema relates to fracture of the bone. This patient is being treated with crutches as well as a metabolic analysis and will be rescanned to assess for healing.
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