Korean J Radiol.  2014 Dec;15(6):792-796. 10.3348/kjr.2014.15.6.792.

Osteochondral Lesion of the Bilateral Femoral Heads in a Young Athletic Patient

• Lee JE
• Ryu KN
• Park JS
• Cho YJ
• Yoon SH
• Park SY
• Jin W
• Lee KR

• KMID: 1794651
• DOI: http://doi.org/10.3348/kjr.2014.15.6.792

Abstract

Osteochondral lesions of the femoral head are uncommon and few studies have reported their imaging findings. Since joints are at risk of early degeneration after osteochondral damage, timely recognition is important. Osteochondral lesions of femoral head may often be necessary to differentiate from avascular necrosis. Here, we report a case of osteochondral lesions on bilateral femoral heads. This lesion manifested as subchondral cysts in initial radiographs, which led to further evaluation by computed tomography arthrography and magnetic resonance imaging, which revealed overlying cartilage defects.

Keyword

Osteochondral lesion; Femoral head; Athlete; Arthrography

MeSH Terms

Female
Hip Joint/abnormalities/*radiography
Humans
Magnetic Resonance Imaging
Osteochondritis/*diagnosis
Patients
Sports
Tomography, X-Ray Computed
Young Adult

Figure

• 

  Fig. 1 Osteochondral lesions of bilateral femoral heads in 20-year-old female. A. Plain radiography image of right hip shows several subchondral cysts in superior portion of femoral head. Left femoral head shows no remarkable finding. B. Coronal CT arthrography image of right hip show several subchondral cysts with overlying articular cartilage defects and fissuring (arrows) in superior portion of right femoral head. C. Lesion shows hypointensity on coronal T1-weighted MRI (TR/TE, 374/20) (T1WI) (arrows) and hyperintensity on sagittal T2-weighted MRI (TR/TE, 1500/29) (T2WI) (arrows) that were immediately obtained after CT arthrography. Overlying articular cartilage defects and fissuring are noted. No evidence of bone marrow edema of femoral head is present. D. One year after surgery on right hip, plain radiography of left hip demonstrates several subchondral cysts in superior portion of left femoral head. Surgical bone change of core decompression with bone graft is noted on right femur. E. Sagittal CT arthrography image of left hip show newly developed several subchondral cysts with overlying cartilage defects and fissuring (arrow) in superior portion of left femoral head. TE = echo time, TR = repetition time. F. Coronal T1-weighted MRI (TR/TE, 374/20) (T1WI) and sagittal T2-weighted MRI (TR/TE, 1500/29) (T2WI) show similar lesion, which manifested in right femoral head. G. MRI of local referral hospital obtained 2 months before first visit to our hospital. Coronal T1WI (TR/TE, 666/12) shows wedge shaped area of hypointensity in superomedial portion of left femoral head (arrow). Coronal T2WI with fat suppression (TR/TE, 4460/57) shows corresponding area of hyperintensity (arrow). Overlying articular cartilage is difficult to observe on these images. Subchondral cysts are seen in right femoral head. TE = echo time, TR = repetition time

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