Age / Sex : 77 / F

Chief complaint: both hip pain (Rt < Lt), LROM, limping gait

1) What is your impression?

Two weeks later, you can see the final diagnosis with a brief discussion of this case.

* Send Application Answers to Jae Hyuck Yi, MD (yijh@knu.ac.kr)
(Quiz는 quiz일 뿐이오니 답안은 한개만 보내주시기 바라오며, 복수의 답안을 보내주시는 분은 정답이 포함되어 있더라도 부득이 semi-correct answer로 처리토록 하겠습니다.)

Courtesy :  Hong Suk-Joo, MD, Korea University Guro Hospital

Transient bone marrow edema syndrome

Discussion

Findings: Diffuse T1 low, T2 high signal intensity bone marrow change with diffuse enhancement is seen in left femoral head and neck, intertrochanteric region, proximal diaphysis, partially in right femoral head-neck junction.

 Reactive joint effusion and synovitis are combined in both hips, more in left side.

Differential Diagnosis: Osteonecrosis

Diagnosis: Transient bone marrow edema syndrome

Discussion:  Transient bone marrow edema syndrome

•      Firstly described on 1959, by Curtiss and Kincaid

–     A syndrome of transient demineralization of the joint

•      Unknown pathogenic mechanism

•      Mainly affects the hip, the knee, and the ankle

•      Middle-aged males, rarely women in the 3^rd trimester of pregnancy.

•      Self-limited nature.

•      Plain radiographs :

–     Normal in early stage

–     Periarticular osseous demineralization(3-6wks)

–     Joint space remains intact and no subchondral lesions are evident.

–     Self limited (~2years)

•      MRI :

–     High SI compared with normal bone marrow on fat-suppressed T2-WI and short-tau inversion recovery (STIR) images.

–     Low SI on T1-WI.

–     Enhancement of the BME area

•      Bone scintigraphy, c Tc 99m-MDP :

–     Increased uptake in the affected joint

References:

1. Resnick D, Bone and joint imaging. Saunders, Philadelphia 2005

2. Anastasios V. Korompilias et al. Bone marrow edema syndrome. Skeletal Radiol 2009;38:425–436