CASE 38
By: Dr. Mai Mattar, MD & Dr. Nizar Al-Nakshabandi MD, FRCPC
HISTORY: A 40-year-old male presented with right-sided hip pain.
The patient was treated conservatively and improved after a few weeks’ time. He presented two years later with pain in the contralateral hip.
What are your findings?
What is the differential diagnosis?
What are the causes?
FINDINGS:
Coronal T1 and T2FS images of the pelvis. The first set demonstrate right hip edema, whereas the second set of images demonstrate edema within the left hip. There is no fractures or subchondral collapse identified. No joint effusion.
DIFFERENTIAL DIAGNOSIS:
Migratory osteoporosis.
Stress fracture.
Infection.
Neoplastic edema.
Stress fracture.
Reflex sympathetic dystrophy.
DIAGNOSIS:
Transient migratory osteoporosis.
PEARLS AND DISCUSSION:
This is a disease of exclusion. A follow-up MRI is important to ensure resolution and to exclude any underlying pathology.
It was initially described in pregnancy; however, it is more common middle-aged men [men in their 50s].
The male to female ratio is 3-1. If it occurs in a female, it is usually in the third trimester of pregnancy.
Only one hip is affected at a time. Occasionally it can occur in the same hip.
When it develops in other joints it is termed regional migratory osteoporosis.
Because it resolves spontaneously treatment focuses on minimizing symptoms and decreased damage to the surrounding bone. Nonsteroidal anti-inflammatory drugs, weightbearing restrictions, physical therapy, and alternatives as described including vitamin D and calcium can be used.
FURTHER READING:
Bin Abdulhak AA, Ba-Mougadam FA, Al-Nakshabandi NA, Al-Tannir MA. Transient osteoporosis of the hip/bone marrow edema syndrome with soft tissue involvement: a case report. Oman Med J. 2011 Sep;26(5):353-5. doi: 10.5001/omj.2011.86.
Hayes CW, Conway WF, Daniel WW. MR imaging of bone marrow edema pattern: transient osteoporosis, transient bone marrow edema syndrome, or osteonecrosis. Radiographics. 1993;13 (5): 1001-11.
Stoller D, Tirman P, Bredella M et-al. Diagnostic imaging: Orthopaedics. AMIRSYS. (2004) ISBN:0721629202
