Age / Sex : 12 / M

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.