Osteonecrosis of the humeral head

Case contributed by Dr Abraão Kupske

Presentation

Shoulder pain. No more information provided.

Patient Data

Age: 45 years
Gender: Female

No significant abnormality.

Serpiginous peripheral /outer dark (sclerosis) and inner bright (granulation tissue) on T2WI in the proximal humeral head (double line sign). There is no evidence of subchondral collapse.

Case Discussion

The humeral head is considered the second commonest location for osteonecrosis. It is also known as Hass disease.

Radiography is not sensitive to early changes of osteonecrosis. MR imaging is generally regarded as the most sensitive and specific image modality for identification of this pathology.

The most common MR imaging pattern seen is an area of yellow marrow surrounded by a low-signal-intensity rim with all pulse sequences. This imaging appearance corresponds to a rim of sclerosis and is associated with a high signal line on T2 weighted sequences that consists of granulation tissue (double line sign).

Despite aggressive management, many patients with osteonecrosis progress to subchondral collapse and secondary osteoarthritis and require a reconstructive procedure.

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