Avascular necrosis - bilateral femoral heads

Case contributed by Dr Sameh Saied Ali


A body-builder presents with constant right hip pain for the last one month. He gives a history of steroid injections

Patient Data

Age: 25 years
Gender: Male

Bilateral femoral heads show geographic areas of abnormal signal intensity involving the superior articular surface, with the right femoral head more severely affected.

On the right side, the area of abnormality is a mixed signal pattern, with areas of high and low signal on the T1 and T2 weighted images. Specifically, there is a serpentine low signal intensity line surrounding the central abnormal signal representing the reactive interface that separates normal marrow from infarcted marrow. The STIR images show ill-defined zone of marrow edema extending to the femoral neck. There is articular surface flattening and cortical irregularity. Narrowing of the lateral aspect of the joint space is seen. 

On the left side, the area of bone necrosis corresponds to a fat-signal pattern on the different pulse sequences. The double line sign is more distinct on the left side, where the boundaries of the lesion have an outer dark signal layer and inner bright signal layer. 

According to Ficat & Alert classification, right grade III and left grade II AVN of the femoral heads.

Case Discussion

MRI has proved its ability for early diagnosis and accurate staging of AVN of the femoral heads which have significantly impacted patient management and prognosis.

Patients usually presented with unilateral hip pain or sometimes referred knee pain. Past history of prolonged corticosteroid intake is typical. Other possible causes include pancreatitis, trauma, and sickle cell disease. 

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Case information

rID: 65159
Published: 19th Jan 2019
Last edited: 22nd Jan 2019
Tag: femur, avn
Inclusion in quiz mode: Included

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