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8b - Answer: 63-year-old male presents with extreme pain in front right hip

Pomeranz, Stephen
Stephen J Pomeranz, MD
Chief Medical Officer, ProScan Imaging. Founder, MRI Online
Includes DICOM files

HISTORY: 

This 63-year-old male presents with severe, extreme pain in front right hip when moving. Injury from pulling and lifting at work. Symptoms came suddenly and worsening. Difficultly with walking, stairs and twisting.

PRIMARY FINDING: 

Osteoarthrosis.

Using the diagnostic web viewer, we have provided images that assist in telling our clinical story. Areas of significance are indicated below.

FINDINGS:

No acute bony macrofracture or contusion. No AVN. Complete loss of femoroacetabular joint space. Extensive osteochondral erosion of the acetabulum and the femoral head. Coxa vara with loss of sphericity of the femoral head. Chronically macerated labrum. Moderate amount of joint effusion.

No acute muscle or tendinous strain.

Mild spurring of the left acetabulum. Coxa vara of left femur.  

SI joints and pubic symphysis unremarkable. 

IMPRESSION:

Right Hip: Advanced right hip osteoarthrosis with loss of joint space, extensive osteochondral erosion and stress edema, spurring and macerated labrum. Findings predisposed by cam-type femoroacetabular impingement but now, overcoverage and hypertrophic spurring.  

Moderate amount of joint effusion.

LESSON 2, TOPIC 24

Case Challenge: Hip MRI Cases

Case Challenge

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Content reviewed: July 28, 2021

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