The radiograph can easily be passed off as normal. However, there is a subtle subchondral lucency in left femoral head.
An MRI was advised for the same.
There is evidence of avascular necrosis in bilateral femoral heads with crescent shape lesions.
Subtle suspicious early cortical collapse seen on left side with minimal reduced joint space.
Avascular zone is involving nearly entire weight bearing area of left femoral head and approx. 60-70% weight bearing of right femoral head.
Marrow edema is seen in neck and intertrochanteric region of left femur.
There is mild synovial effusion on left side.
Case Discussion
MRI findings are suggestive of avascular necrosis of both femoral heads; likely stage 2 on right side and early stage 3 on left side.
This case shows how subtle avascular necrosis can be on radiographs and the importance of performing MRI in suspected cases.
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