47-Year-Old With Left Hip Pain

Differential Diagnosis

• Infection
• Metastasis
• Suspected avascular necrosis of the femoral head

Diagnosis

The image reveals irregular sclerosis of the left femoral head. Avascular necrosis of the femoral head can be traumatic (secondary to femoral neck fractures) or non-traumatic. Traumatic avascular necrosis is usually unilateral. The nontraumatic instances are mostly bilateral in 70-80% of cases.

What to Look For

• Infection typically involves both sides of the joint, and patients have systemic symptoms
• Things to note include: position; percent volume of head and weight bearing surface involved; degenerative changes; joint effusion: osteochondral fragments; fractures.

Pearls for Urgent Care Management

• Causes of avascular necrosis may include: trauma; chronic corticosteroid therapy; alcohol use; tobacco use; systemic lupus erythematosus; hyperlipidemias; HIV; hemoglobinopathies; chronic renal failure; diabetes mellitus; and pregnancy-related conditions.
• Plain radiographs are negative in early disease. In general, there is initial minor osteopenia, followed by variable changes, such as patchy sclerosis and rim calcification. Subchondral lucencies and eventual collapse of the cortical surface with fragmentation and secondary degenerative change may be observed.
• Treatment includes nonoperative intervention with biphosphonates as well as surgical procedures such as total hip replacement.

Acknowledgement: Images and case provided by Experity Teleradiology

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