Age / Sex : 74 / F

Chief complaint : Left hip pain

What is your diagnosis?

Two weeks later, you can see the final diagonosis with a brief discussion of this case (Please submit only one answer).

Courtesy : Sheen-Woo Lee, Gachon University Gil Hospital

Discussion

Answer: Dialysis-related amyloidosis

Findings: Multiple bone erosions in both femoral head and neck. Low signal mass-like material in both femoral head and hip joint (left>right).

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Differential Diagnosis: Tenosynovial giant cell tumor, gout, AVN

Discussion: Deposition of β2-microglobulin in joint of patients undergoing long-term hemodialysis. Conventional radiograph will show cystic radiolucencies with sclerotic rim, without matrix calcifications, commonly in hips, wrists, shoulders, knees, spine. MRI will show mass of low signal intensity, with variable T2 signal as result of combination of amyloid deposits and fluid collection.

References: Dialysis-Related Amyloidosis Revisited, AJR 2005; 185:1460–1467