The following pelvic x-ray is from a 85 year old female patient with long standing bilateral hip pain which is currently more worse on the right side. What can you see?
Magnified view:-[peekaboo_link name=”Answer”]Answer[/peekaboo_link] [peekaboo_content name=”Answer”]
The pelvic x-ray shows abnormal sclerosis of bilateral femoral heads. There is also a subchondral fracture of the right femoral head. The overall appearance is suggestive of bilateral avascular necrosis.
There is an interesting mnemonic for causes of avascular necrosis, which I got off the internet – VINDICATE:
Vascular – sickle cell anaemia
Infection – septic emboli/ Idiopathic
Drugs/toxins – steroids, alcohol
Inflammatory – pancreatitis
Congenital – Gaucher’s disease
Autoimmune – SLE, Rheumatoid
Trauma – fracture/dislocation, dysbarism, radiation
Endocrine/metabolic – Cushing’s
Our patient did not have any of the risk factors above, so the AVN is likely idiopathic..[/peekaboo_content]