Presentation
Severe right-sided hip and groin pain for three weeks. Limping. No trauma. History of rheumatoid arthropathy ? bony abnormality
Patient Data
Radiolucency is seen at the superolateral aspect of the right femoral head.
Joint space is preserved.
No femoral head remodeling.
Given this is the patient's symptomatic side, MRI pelvis is advised to exclude osteonecrosis.
The femoral head bilaterally abnormal aspherical morphology with flattening of the anterior superior aspect of articular surface with some background fragmentation. More than 50% of the femoral head surface is affected as seen on coronal plane. Appearance in keeping with advanced avascular necrosis (AVN). Right side is more severe than the left. There is bilateral effusion.
Degenerate changes characterized by loss of joint space is noted. Acetabulum appears intact. No trochanteric bursal fluid. Surrounding muscles, muscle planes are normally demonstrated.
Advanced bilateral femoral head AVN, right side relatively more severe than the left.
Case Discussion
Patient had known systemic lupus erythematosus (SLE), which was not documented on request form for pelvis x-ray.
SLE is a risk factor for osteonecrosis.
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