CASE 68
By: Dr. Amna Kashgari MD,SSC-Rad
HISTORY: A 6-year-old boy with left hip pain and limitation of movement for two weeks.
What is your findings?
What is your differential diagnosis?
What is your most likely diagnosis?
FINDINGS:
Frontal radiograph of the pelvis shows flattening, sclerosis and early fragmentation of the left femoral head. Irregular physeal plate noted.
DIFFERENTIAL DIAGNOSIS
Legg-Calvé-Perthes disease.
Sickle cell diseas.
Gaucher’s disease.
Septic arthritis.
Hypothyroidism.
Spondyloepiphyseal dysplasia.
Meyer’s disease.
DIAGNOSIS
Legg-Calvé-Perthes disease.
PEARLS AND DISCUSSION:
Legg-Calvé-Perthes disease is idiopathic avascular necrosis of the femoral head.
It usually affects children aged 2-14 years.
Boy: girl ration 5:1.
Bilateral disease occurs in 10-20%.
Risk factors:
Male.
Low birth weight.
Low socioeconomic group.
presence of an inguinal hernia.
genitourinary tract anomalies.
Patho-physiology:
Lack of blood supply to the femoral epiphysis. Ischemia disrupts growth of the femoral head. The femoral head become dense and fragmented and resorbed.
During treatment phase, the femoral head reossification occur and the bone reshaped with deformity.
Imaging findings:
Plain radiograph:
Early stage:
Normal.
Femoral head osteopenia.
Crescent sign: subchondral lucency.
Irregular femoral head.
Widening of medical joint space due to joint effusion.
Late stage:
Fragmentation of the femoral head.
Femoral head deformity with widening and flattening (coxa plana).
Proximal femoral neck deformity: Coxa magna.
Bone scan:
Photopenic area in proximal femoral epiphysis because of interruption of blood supply to epiphysis.
MRI scan:
For early diagnosis and assessing extent of cartilaginous involvement:
On T1 and T2 WI shows irregular foci of low signal intensity or linear segments replace the normal high signal intensity of bone marrow.
Intra-articular effusion.
Small, laterally displaced ossification nucleus.
Labral inversion.
Femoral head deformity.
Treatment:
Medical treatment to control the symptoms.
Surgical management may be needed.
FURTHER READING:
Lane F Donnelly. Fundamental of pediatric radiology. ISBN-13: 978-0721690612
Johan G Blickman, Bruce R Parker, Patrick D Barnes. Pediatric Radiology: The Requisites, 3e. ISBN-10: 0323031250
