Case Author(s): michael quinn, md and mark mintun, md , 3/20/98 . Rating: #D2, #Q4

Diagnosis: avascular necrosis

Brief history:

20 yo male with right hip pain


anterior and posterior immediate images

View main image(bs) in a separate image viewer

View second image(bs). anterior and posterior whole body images

View third image(xr). AP pelvis radiograph

View fourth image(xr). AP pelvis radiograph (approx. 1 year earlier)

Full history/Diagnosis is available below

Diagnosis: avascular necrosis

Full history:

20 yo male with left iliac wing Ewing sarcoma diagnosed nearly one year prior to this study. It was initially treated with radiation and chemotherapy after which he received a bone marrow transplant. His current medications include Cytoxan and steroids. The patient complains of right hip pain beginning nearly one week prior to this study.




On immediate static images, there is decrease in activity corresponding to the right femoral head and slightly increased activity just inferior to the femoral head. The delayed images demonstrate similar decrease in the right femoral head with increased uptake in the adjacent aspect of the femor. There is decreased uptake within the lower lumbar spine. Additionally, there is mild, diffuse increase in activity corresponding to the left iliac bone.


The decreased right femoral head activity, in conjunction with the patient's current complaints of right hip pain, are the classic appearance of avascular necrosis. The adjacent area of increased activity in the femor most likely represent early bony remodeling. The steroid therapy following bone marrow transplant is the likely etiology for the infarct in this case. The iliac wing activity represents bony remodeling after chemotherapy and radiation for Ewing sarcoma in this location. The mild decrease in lower lumbar spine activity represents post-radiation change that occurs in previously normal bone, as the resulting hypoplastic marrow space is replaced by fat and, to a lesser extent, fibrosis.

Differential Diagnosis List

Pancreatitis, alchohol abuse, sickle cell disease, fracture, steroids, and radiation may all cause avascular necrosis. There is also an idiopathic form seen in children (Legg-Calve-Perthes disease).

ACR Codes and Keywords:

References and General Discussion of Bone Scintigraphy (Anatomic field:Skeletal System, Category:Misc)

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Case number: bs092

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