Proximal Femur Marrow Oedema Posted By Dr. K. M. Marya Date : 21-Jan-06
I have a patient who is 36 years old male in a sedentary life syyle complaining of continuous pain left thigh, hip and sometimes radiating to knee. Both hip and knee movements painfree and all clinical tests negative. NSAIDS were prescribed to no effect. After about 2 months, patient developed tender point medially on thigh over the adductors proximally. Xray showed only mild sclerotic changes on femoral head in the weight bearing area. An MRI was done yesterday [as I could'nt reach a conclusion because pt had no H/O trauma, fever, infection, weight loss, other sites of pain and all blood investigations were normal] and it shows femoral marrow oedema and changes of very early AVN ??? [serpentine low signal intensity at subcortical location] in femoral head. These femoral head changes are peculiarly bilateral though contralateral side is asymptomatic. I dont have much experience with this kind of situation. Should a conclusive diagnosis of AVN be made or to traet him symptomatically and repeat MRI / Scan in 6 months? No contributary factors for ANN present in this case. I would like some information in this regard please. Thanks everyone!