Presentation
Left-sided hip pain no recent trauma.
Patient Data
The left hip demonstrates severe loss of joint space superiorly with widening of the medial portion of the femoroacetabular articulation. There is flattening of the superolateral femoral head with large subchondral cyst formation and patchy areas of sclerosis. Attending osteophytes are noted in a collar like distribution around the left acetabulum. Mild loss of joint space, osteophyte formation, and acetabular subchondral cysts are noted in the right femoroacetabular articulation without evidence of collapse.
Advanced loss of intervertebral disc space with osteophytes and vacuum phenomenon are observed in the lower lumbar segments.
Enthesophyte formation at the superior aspect of the greater tuberosity bilaterally.
Case Discussion
This case demonstrates advanced osteoarthrosis of the left hip with radiographic changes (sclerosis and flattening of the femoral head) that could represent avascular necrosis. However, the gold standard for diagnosis of AVN is MR imaging in which a double line sign is a pathognomonic finding.
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