Interactive Transcript
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Here's another patient with hip pain.
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This is a 10-year-old girl with left hip pain.
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I'm not going to show you the radiographs.
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Basically, the radiographs demonstrated
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findings of a left hip effusion, which
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I think is well illustrated here on this
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coronal fluid-sensitive fat-suppressed sequence.
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We're looking at the left hip
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here and the right hip over here.
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What do we notice immediately?
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Well, I immediately notice that there is a
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pretty good-sized effusion on the left side.
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And one word I want to point
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out about hip effusions.
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Hip effusion is probably the single
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most important thing that you should
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be looking for when a child comes in
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with hip pain on a plain radiograph.
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Because hip effusion means that
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there's something wrong with that hip.
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You don't know what's wrong.
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It could be an infection, it could be
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avascular necrosis, it could be something
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like this, but there's something that's
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irritating that area and that joint.
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And the body reacts to any sort of irritation
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by sending fluid and inflammation to it.
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So when you have a joint effusion,
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you don't know what's causing it,
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but you know there's something wrong.
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So that's why the plain
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radiographs are important.
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are really important for you to look
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for subtle changes of hip effusion.
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So once you have it, then you get other
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imaging, ultrasound, MRI, what have you,
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depending on your clinical suspicion.
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So I just want to throw that out there.
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So this patient has a left hip effusion.
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And what do we notice besides the hip effusion?
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Well, there is a geographic area.
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I call it geographic because I feel like
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I can take a marker, like this, and I can go
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like that.
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All the way around, like this, like
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this, and define the area of abnormality.
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So, what's going on over there?
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Well, we know it's edematous, and it's
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geographic, and it has caused a joint effusion.
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What if we gave contrast?
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What does this look like if we give contrast?
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Let us go ahead and bring the
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contrast images over here.
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And there is a little bit of enhancement there.
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Let me convince you that it really does enhance
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by bringing you a pre-contrast image. I'll put
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this back here. A pre-contrast image is here.
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One word of warning is, if you see
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something bright on a post-contrast
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image, how do you know it's actually
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enhancing unless you have a pre-contrast?
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Because it may have been intrinsically
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bright, T1 bright to begin with.
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Always compare your post-contrast
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images with your pre-contrast images.
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And here I think you can be convinced that
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this, in fact, is an area of enhancement.
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It's not just this area that's
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enhancing, but also the synovium.
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is enhancing.
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Well, there is a geographic area.
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I call it geographic because I feel like
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I can take a marker, like this, and I can go
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like that.
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All the way around, like this, like
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this, and define the area of abnormality.
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So, what's going on over there?
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Well, we know it's edematous, and it's
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geographic, and it has caused a joint effusion.
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What if we gave contrast?
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What does this look like if we give contrast?
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Let us go ahead and bring the
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contrast images over here.
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And there is a little bit of enhancement there.
2:03
Let me convince you that it really does enhance
2:05
by bringing you a pre-contrast image. I'll put
2:09
this back here. A pre-contrast image is here.
2:11
One word of warning is, if you see
2:13
something bright on a post-contrast
2:15
image, how do you know it's actually
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enhancing unless you have a pre-contrast?
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Because it may have been intrinsically
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bright, T1 bright to begin with.
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Always compare your post-contrast
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images with your pre-contrast images.
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And here I think you can be convinced that
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this, in fact, is an area of enhancement.
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It's not just this area that's
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enhancing, but also the synovium.
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is enhancing.
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So where you had joint effusion
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before, the synovium is rotated.
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So you have synovial enhancement, joint
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effusion, and this funny geographic area of
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abnormal signal sort of in the mid femoral head.
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So this is a condition called
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idiopathic chondrolysis.
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Idiopathic chondrolysis, as the name would
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imply, is unknown why it happens, but there
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actually is a very high association with
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juvenile idiopathic chondrolysis.
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arthritis, or JIA, juvenile
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idiopathic arthritis.
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In fact, the several cases that I
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have seen, eventually those patients
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have been diagnosed with JIA.
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So when you see a pattern like this, first
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recognize it for the condition that it is,
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which is idiopathic chondrolysis, and you
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want to mention, hey, could this be JIA?
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If so, maybe the rheumatologist should
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see this patient, maybe some arthritis
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markers should be run, as a blood test.
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