Avascular necrosis - bilateral femoral heads

Case contributed by Mohammad A. ElBeialy
Diagnosis almost certain


Bilateral hip pain

Patient Data

Age: 50 years
Gender: Female

Frontal radiographs show mild collpase of both femoral heads with patchy sclerosis and lucency, as well as mild secondary degenerative changes of the hip joints including narrowed joint spaces.

  • both femoral heads appear partially collapsed, with subchondral hypointense fracture lines and patchy sclerosis. Surrounding marrow edema of the proximal right femur, minimal on the left
  • mild subchondral degenerative changes of both acetabulae, more evident on the right side with subchondral pseudo-cystic changes. Relatively narrowed both hip joint spaces, more prominent on the right side
  • mild bilateral hip joint effusions
  • symmetric fatty atrophic changes of gluteal, tensor fascia, and sartorius musculature

Case Discussion

Bilateral femoral avascular necrosis (AVN) stage IV, with proximal femoral marrow edema more on the right side, as well as mild secondary degenerative changes and small joint effusions.

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