IS Case 617: Avascular necrosis left femoral head
Imaging Sciences URMC 2011
Publication Date: 2011-12-12
History
Patient is a 12-year-old male with history of fall, previous traumatic subcapsular hepatic hematoma status post drainage, with new left hip pain. Question possible source of infectious etiologies.
Findings
Plain films show no acute fracture or dislocation. CT findings demonstrate a small joint effusion with loculated fluid collection posterior to the femoral head. MRI findings demonstrate a heterogeneous left femoral epiphysis with mild loss of height of the femoral head. Follow-up CT demonstrates fracture of the femoral metaphysis and avascular necrosis of the left femoral head.
Diagnosis
Discussion
Avascular necrosis of the hip, usually aseptic in origin, has a variety of causes ranging from systemic medical conditions such as sickle cell disease, systemic steroid use, post renal transplantation, and Gaucher's disease to direct trauma. There is a compromised blood supply to the proximal femoral epiphysis, and this may be associated with increased intramedullar pressure and venous stasis in the epiphysis. MRI imaging of the hips in the pediatric population has a variety of advantages, including better visualization of cartilage when compared to plain film and CT imaging. It can be utilized to evaluate normal developmental anatomy as well as sequelae of trauma.
References
- Gabriel H, Fitzgerald SW, Myers MT, Donaldson JS, Poznanski AK. MR imaging of hip disorders. Radiographics 1994 Jul;14(4):763-81. PMID: 7938767
- Vidigal Júnior EC, Vidigal EC, Fernandes JL. Avascular necrosis as a complication of septic arthritis of the hip in children. Int Ortho 1997;21(6):389-92. PMID: 9498149
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