• Save
Legg- Calve – Perthes disease
Upcoming SlideShare
Loading in...5
×

Like this? Share it with your network

Share
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Be the first to comment
No Downloads

Views

Total Views
1,530
On Slideshare
1,522
From Embeds
8
Number of Embeds
6

Actions

Shares
Downloads
0
Comments
0
Likes
1

Embeds 8

http://www.facebook.com 2
https://www.facebook.com 2
https://m.facebook.com&_=1370890292259 HTTP 1
https://m.facebook.com&_=1370871522207 HTTP 1
https://m.facebook.com&_=1370914101096 HTTP 1
https://m.facebook.com&_=1370917168162 HTTP 1

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
    No notes for slide
  • I
  • I
  • I
  • I

Transcript

  • 1. Case StudyMay 25th, 2012Reported by Dr. Giang
  • 2.  Name: Tran Thi Thu Phuong Sex: Female Age: 10 years old Dept: Outpatient
  • 3. Clinical Right hip pain Limp No fever History: no trauma
  • 4. MRI Findings(T2WI, Coronal, Pre C+) Right femoral head : Flattening ( 7mm) Left femoral head: normal ( 13mm) No hip joint dislocated
  • 5. MRI Findings(T2WI, Axial, Pre C+) Right hip joint effusion: hyperintensity Right articular cartilage: irregular thickness Epiphyseal marrow: hypointensity.
  • 6. MRI Findings(T1WI, Coronal, Pre C+) Right intraarticular effusion: hypointense Irregular articular border. Epiphyseal marrow center: hypointense(necrosis)
  • 7. MRI Findings(T2FS, Coronal, Pre C+) Right femoral neck: Hyperintense
  • 8. MRI DiagnosisAvascular necrosis of right femoral epiphysis Grade II(Legg- Calve – Perthes disease)
  • 9. Legg Calve DiseaseBackground Definition: Necrosis of osseous epiphysis offemoral head classified as an osteochondrosis Location: Proximal femoral epiphysis15 to 20% with bilateral involvement Age:o 3-12 yearso Median = 7 years Gender: M:F = 4-5: 1
  • 10. Legg Calve DiseaseBackground Clinical symptom:- No history of trauma- Limp + hip, thigh or knee pain .- Leg length inequality.- Thigh atrophy.- Decrease range of motion (internal rotation& abduction)
  • 11. Legg Calve DiseaseBackground Prognosis:- Younger age of presentation = better prognosis- > 8 years old = poor prognosis Treatment:1. Conservative:- 50% improve with no treatment- Bed rest + abduction stretching & bracing2. Surgical:Femoral/pelvic osteotomies to contain hip
  • 12. ClassificationCatterall classification: Based on extent of epiphysealinvolvement Group I : < 1/4 epiphysis involved Group II : < 1/2 epiphysis involved Group III : Most of epiphysis involved Group IV : All epiphysis involved
  • 13. ClassificationSalter - Thompson: Extent + location ofsubchondral fractureo A = fracture < 50% span of epiphysiso B = fracture> 50% span of epiphysis
  • 14. Imaging Diagnosis Method1. X ray2. CT scanner3. Bone scintigraphy4. MRI
  • 15. X-RAY FINDINGS Effusion, fragmentation + flattening of sclerotic capitalepiphysis Metaphyseal irregularity (rarefaction of lateral + medialmetaphysis + cystic changes) Joint space (inferomedial) widening + intact subchondralplate Catterall classification (group I-IV) estimates amount offemoral head involvement
  • 16. Perthes bilateral.
  • 17. X-RAY FINDINGSWaldenstroms radiographic staging1.• Initial stage = increased head-socket distance,subchondral plate thinning + dense epiphysis2.• Fragmentation stage = subchondral fracture,inhomogeneous dense epiphysis + porous appearance +metaphyseal cysts3.• Reparative stage = normal bone in areas of resorption +removal of sclerotic bone + more homogeneous epiphysis4.• Growth stage = approaches normal femoral shape5.• Definite stage = final shape (joint congruency vs.incongruency)
  • 18. MRI FINDINGSProtocol: T1WI, T2WI, STIR, T1 C+ (coronal & axial)1. T1WIo Hypointense intraarticular effusiono Hypointense irregularity along periphery ofossific nucleus (diem cot hoa)o Linear hypointensity traversing femoralossification center (trung tam cot hoa) in earlystageso Revascularization of necrotic epiphysis =replacement of hypointense focus with marrow fatsignal intensity
  • 19. MRI FINDINGS2. T2WI- FS PD or T2 FSEimages to assess articular cartilage thickness+ chondral irregularities- Physeal cartilage ± hyperintense on T2WI - in early stagedisease- Loss of femoral head containment in acetabulum• Intermediate signal hypertrophied synovium in iliopsoasrecess• Thickening of intermediate signal epiphyseal cartilage-Hyperintense joint effusionSagittal T1 + T2WI also useful to display acetabular + femoralhead cartilage
  • 20. MRI FINDINGS3. STIR± Hyperintense femoral head + hyperintense neckedema /& effusion
  • 21. MRI FINDINGS4. T1 C+Decreased enhancement with gadolinium in earlyavascular necrosisNo enhancement
  • 22. MRI FINDINGSSagittal T1 + T2WI also useful to display acetabular +femoral head cartilage
  • 23. Different Diagnosis1. Toxic synovitis: Self-limiting acute synovitis (3 to 10 days) •Boys < 4 years Minimal thigh atrophy Improves in < 5 days with bedrest + anti-inflammatory medications Significant effusion + capsular distension
  • 24. Different Diagnosis2. Septic HipAcute ill& feverJoint effusion +/- joint debris +/- reactivemarrow 7 Increased white blood cell count +sedimentation rate Hips held in flexion, abduction (dang) +external rotation vs. hip adduction (khep) inPerthes edema
  • 25. Different Diagnosis3. Juvenile Chronic ArthritisLimp + hip painChronicity + thigh atrophyFever + rash + positive antinuclear antibodyEpiphyseal erosions (an mon)
  • 26. Different Diagnosis4. Slipped Capital Femoral Epiphysis Posterior-inferior displacement of proximalfemoral epiphysis Pain + limp Limitation of internal rotation + abduction
  • 27. Different Diagnosis5. Osteoid Osteoma (u xuong dangxuong)Local pain worse at night, decreased bysalicylates Local swelling + point tendernessExtensive marrow edema on FS PD FSE orSTIR
  • 28. Thank you for attention!