Presentation
Chief complaint: Left hip pain. The patient came to the emergency department for hip pain. At that time, he reported constant left groin pain radiating to the left knee.
Patient Data
No definite acute fracture or dislocation.
There are mild bilateral hip degenerative changes with marginal osteophytes, the joint spaces are grossly preserved.
There is a slight heterogeneous appearance of the left femoral head with small areas of lucencies, the largest towards the lateral aspect. The findings might be in the spectrum of degenerative changes with subchondral cysts, however underlying AVN cannot be ruled out. No definite cortical undermining or flattening of the femoral head.
Serpiginous areas of mixed T1 and T2 signal within the bilateral femoral heads, left greater than right. Findings are suggestive of avascular necrosis. The area of necrosis within the left femoral head measures approximately 3 cm in the coronal plane while on the right measures approximately 2.1 cm.
There is extensive bone marrow edema within the bilateral femoral necks, intertrochanteric region, and subtrochanteric regions with low T1 and high T2 signals There is a 1.7 cm proteinaceous cyst within the left femoral head.
There is mild bilateral femoroacetabular joint cartilage loss with early osteophyte formation. Trace right and moderate left hip joint effusions are present. No labral tear is definitively visualized. No flattening of the humeral heads. Bilateral femoral heads are normal in morphology.
The iliopsoas and gluteal tendons on the left are intact. No intramuscular edema.
IMPRESSION:
bilateral femoral head avascular necrosis, greater on the left. No flattening of the femoral heads
superimposed mild bilateral hip osteoarthritic changes. Trace right and moderate left hip joint effusions
extensive bone marrow edema within the bilateral femurs
Case Discussion
A case of bilateral avascular necrosis of the hip with typical MR features.
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