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
Images:
anterior and posterior immediate images
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anterior and posterior whole body images
View third image(xr).
AP pelvis radiograph
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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.
Radiopharmaceutical:
Tc-99m-MDP
Findings:
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.
Discussion:
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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