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Tuesday, 7 April 2015

CASE 304: HIP PAIN, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

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Man 43 yo, one week ago, pain at  his left  hip  while moving his thigh, no trauma history.
Ultrasound first saw  the  left hip joint  having a small amout of fluid collection  and  more  Power Doppler in muscles  around the hip ( see 4 US images).





MSCT was done but radiologist said nothing abnormal detected.




MRI detected abnormal head of left  femur  bone  looked like  aseptic necrotic femoral head.




Please compare  diagnostic values of 3 diagnostic modalities for this case:ultrasound, MSCT and MRI.

DISCUSSION:
In this case  ultrasound first  saw abnormal edema in the left hip joint. CT  scanning  cannot  detected  at the early stage  of  head femoral AVN disease ( AVN, avascular necrosis). MRI  was the best  imaging modality for  diagnosing  AVN  in this case. Early  diagnosing  may cause  good response  to medical treatment.

1 comment :

Dr.Hai Phuong said...

AVN is a typical reserved for subchondral osteonecrosis. Therefore,MRI is considered the method of choices for early stage AVN diagnosis.
Speaking about accuracy, it was reported 88% sensitivity, 100% specificity, and 94% accuracy with 1.5TMRI. Whereas, osteoporosis is the early stage AVN CT finding with 55% sensitivity.
Early AVN usually asymptomatic, this patient is fortunately detected due to his pain.
Ref:emedicine.medscape.com