Presentation
Longstanding shoulder pain.
Patient Data
Age: 40 years
Gender: Male
From the case:
Bilateral osteonecrosis of the humeral head
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- bilateral old subchondral fractures with associated sclerosis and humeral head collapse and fragmentation
- the left humeral head has a crescent lucency adjacent to the subchondral fracture
- the imaged hemithoraces are unremarkable
Case Discussion
This is a case of bilateral humeral head osteonerosis (Haas disease).
Osteonecrosis of any bone in the body carries a fairly well-known differential list (including but not limited to trauma, radiotherapy, steroid use, sickle cell disease etc).
This patient has HIV, which is also a risk factor for osteonecrosis. The aetiology of HIV associated osteonecrosis is not entirely clear, however is thought to be from a combination of immune activation, chronic inflammation and activation of coagulation pathways.