Presentation
The patient had a history of chronic alcohol consumption exceeding 400 mL of ethanol per week for the past 30 years.
Patient Data
Rx left shoulder
Stage II osteonecrosis is characterized by a zone of osteopenia surrounding a zone of relatively increased osseous density, with the sphericity of the humeral head preserved. Also the shoulder joint space is still preserved.
There is a increase relative in density in the humeral head (light blue arrows). The shoulder joint space is still preserved.
MRI left shoulder
Double line sign (inner bright line from granulation tissue and outer dark line from sclerotic bone) on T2-weighted images. There is a little cystic lesion in the proximal humerus with focal full-thickness supraspinatus tendon tear.
Case Discussion
Avascular necrosis of the shoulder is a condition characterized by interruption of blood supply to the humeral head which may lead to humeral head sclerosis and subchondral collapse. The hypothesis that alcoholism-induced bone necrosis is caused by fat embolism linked to co-existent hyperlipidemia.
Radiographer: TSRM Fabio Imola