Case Challenge

Hip & Thigh

Stephen J Pomeranz

Gain confidence interpreting Hip MRI with practice cases from MRI Online. Quiz yourself using real-world DICOMs & earn CME. Try it free!

Case Review

Musculoskeletal (MSK)

Post-Course Activities

This Power Pack is comprised of 25 unique Hip MRI cases that you can scroll through in our diagnostic web viewer to determine your findings. Quiz yourself and earn CME.

Hip MRI Cases

Case 9 - 14-year-old male displayed an abnormal x-ray of the right hip

<div>HISTORY:&#160;This 14-year-old male displayed an abnormal x-ray of the right hip. SUSPECTED PRIMARY FINDING:&#160;Legg-Perthes disease.Using the&#160;diagnostic web viewer, we have provided images that assist in telling our clinical story. Areas of significance are indicated below.FINDINGS:Moderate-sized right hip joint effusion is identified.&#160;Dysplasia of the right acetabulum with broadening and bony remodeling is noted.&#160;Impaction and subchondral osseous edema of the femoral epiphysis is noted.Attention directed to the contralateral hip; physeal irregularity is noted without the inferomedial offset of the epiphysis on the femoral neck, however early slipped capital femoral epiphysis is questioned due to appearance at the superior screws anterior superior femoral metaphysis.Subchondral edema is identified within the dysplastic and widening anterior superior acetabulum.&#160;Chondral labral chronic fraying is identified as well as the dissecting pseudocyst extending to the posterior joint space margin.&#160;Diffuse swelling of the ligamentum teres without frank tear is identified.Surrounding musculature with mild edema.Asymmetric increased signal within the right is skewed tuberosity versus the left side, some of which is not reproduced on the axial T1 sequence and may be an artifact due to edge of film as the spherical gantry is distorted at films edge.CONCLUSION:1. Moderate-sized right hip joint effusion.&#160;Osseous edema seen throughout the femoral head and neck of the right hip in addition to subchondral osseous edema within the weight-bearing portions as well as medial margin of the acetabulum.&#160;Suspect Legg-Perthes with diffuse marrow edema occupying greater than 75 percent cross-sectional area of the femoral epiphysis sparing the posterior-most aspect.&#160;Multiple juxtaphyseal cysts are seen within both the medial epiphysis and anteromedial metaphysis of the dysplastic right hip.2. Dysplastic horizontal appearance of the acetabulum and acetabular labrum with chronic fraying.&#160;Consider joint space aspiration to exclude active infection.3. Widening of the contralateral left hip metaphysis is worrisome for chronic slipped capital femoral epiphysis, although slip is not identified on the current data, neither in the short axis or coronal plane.&#160;Dedicated imaging should be considered.4. Normal signal intensity and the symmetry of the SI joints and distal lumbosacral spine.</div>

Case

What is the suspected primary finding in this case?