Weekly Case

Title : Case 531

Age / Sex : 12 / M


Chief complaint: Pelvic pain, low back pain (onset : 1MA)

What is your impression? 
Two weeks later, you can see the final diagnosis with a brief discussion of this case. (Please submit only one answer)

Courtesy: Yang Ik, Hallym University Kangnam sacred heart hospital


Diagnosis:

Legg-Calves-Perthes disese



Discussion


Findings:


Pelvis AP


Subtle widening of superior & medial joint space on right hip


Flattening and sclerosis of right femoral head


Radiolucent bone densities, heads, femurs, both (right>left)


MR


Subtle widening of superior & medial joint space on right hip


Flattening and sclerosis of right femoral head


Curvilinear low to dark signal intensities on T1WI (right>left)


High signal intensity of bone marrow edemas on T2WI & FST2WI


Small joint effusion, hips, both (synovitis)
 


Differential Diagnosis:


 Hypothyroidism, Sickle cell disease, Gaucher’s disease, multiple epiphyseal dysplasia, multiple spondyloepiphyseal dysplasia – Bilateral fragmentation and collapse.


 Meyer’s dysplasia, dysplasia epiphysealis capitis femoris - epiphysis does not collapse and density and structure remain preserved, Bilateral, no progressive.
 


Diagnosis: Legg-Calves-Perthes disese - idiopathic avascular necrosis (AVN) of the femoral epiphysis seen in children



Discussion:


 Clinical features – often 4~8 years old age child.


                           M:F = 5:1


                           Bilateral involvement on 15~20%., not usually at the same time.


                           Limping, pain, limitation of motion, trauma (25%)


 Radiologic findings – Diffuse edema            


                           Smallness of capital femoral epiphysis.


                           Lateral displacement of capital femoral epiphysis


                           Fissuring and fracture of capital femoral epiphysis


                           Flattening and sclerosis of capital femoral epiphysis


                           Intraepiophyseal gas


                           Metaphyseal cysts


                           Enlargement, widening and shortening of femoral neck.


                           Sagging rope sign


 


References
 


근골격영상의학, 강흥식, 홍성환, 강창호편저, 법문에듀케이션, 서울, 2013,252-253, 637-638,


Stulberg, S. David, Daniel R. Cooperman, and Richard Wallensten. "The natural history of Legg-Calvé-Perthes disease." J Bone Joint Surg Am 63.7 (1981): 1095-1108.


Herring, John A., Hui Taek Kim, and Richard Browne. "Legg-Calve-Perthes disease: part II: prospective multicenter study of the effect of treatment on outcome." JBJS 86.10 (2004): 2121-2134.


Catterall, A. "Legg-Calve-Perthes Syndrome." Clinical orthopaedics and related research 158 (1980): 41-52.



Correct Answer
Total applicants 31 Correct answers 20
Name Institution
홍지현 전문의
김태형 전문의
황지선 전공의
문태용 양산부산대학교병원, 전문의
이동준 분당차병원, 전공의
김동환 군의관, 전문의
박재일 대구 척탑병원, 전문의
박주일 전공의
이혜란 전문의
윤유성 구례병원, 전문의
최형인 전공의
김보람 전공의
김민철 군복무, 전문의
서현주 전문의
장현경 분당차병원, 전공의
여유진 전문의
박준동 뿌리병원, 전문의
정유선 전문의
이지현 병무청, 전문의
신윤상 군의관, 전문의
Semi-Correct Answer
Total applicants 31 Semi-Correct answers 1
정소용 생생병원, 전문의


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