MRI OF THE LEFT HIP
DATE OF STUDY: MM/DD/YYYY
REFERRING PHYSICIAN: John Doe, MD
INDICATIONS FOR STUDY: Left hip pain. Evaluated for AVN. Woke up with left hip pain. Hip pain getting worse despite physical therapy.
TECHNIQUE AND FINDINGS: Multiplanar images were obtained without contrast. The left hip is markedly abnormal compared with that of the right. There is abnormal low signal involving the left femoral head, neck, and intertrochanteric region on T1 that is high signal on the STIR sequences. This is suggestive of edema in the proximal left femur.
There is also some mild edema in the superolateral left acetabulum. There is a prominent left medial joint effusion involving the left hip. There is marked flattening of the superolateral left femoral head.
The left hip appears slightly subluxed laterally, as there is a large medial joint effusion. The acetabulum still appears to cover the femoral head. This may be due to stage IV AVN, which appears as advanced articular collapse and osteoarthritis.
There is a subtle lucent line through the femoral head, on the left, that could be a component of AVN. It possibly could represent a fracture; however, it is more difficult to see on the T1 weighted images and better seen on the STIR sequences. It is suggested on the axial images as well. If clinically warranted, a CT may be of value to ensure there is not an incomplete fracture. On the sagittal images, this linear component is less so appreciated as well. The right hip is fairly normal in appearance. The femoral head on the right is well preserved. There is no flattening of the right femoral head. The right acetabulum is unremarkable. There is no obvious fracture or dislocation on the right. There is no significant joint effusion on the right.
IMPRESSION: Left hip is markedly abnormal compared with that of the right with edema, flattening, and collapse of the superolateral left femoral head. There is a line traversing the subchondral surface of the femoral head that may be a component of avascular necrosis.
Alternatively, this may be related to the closed physis or perhaps an incomplete fracture. Most likely, this probably represents the closed physis. CT may be of value to ensure that there is not an incomplete fracture in this area. The left femoral neck is deformed and misshapened and widened compared with that of the right. This may be due to a longstanding process from a congenital anomaly.
Sequela from perhaps hip dysplasia/dislocation is a possibility as well given the marked asymmetry in the two hips. There is a prominent medial left joint effusion. The right hip is unremarkable.
