Findings
- Coronal T1 TSE, axial & coronal T2 SPAIR sequences reveal focal geographic abnormal T1 hypointense, STIR hyperintense signal in middle one third of left proximal femoral epiphysis and supraacetabular left iliac bone.
- Axial T2 weighted TSE & T2 SPAIR sequences reveal minimal effusion in left hip joint with synovial thickening.
Diagnosis
Idiopathic chondrolysis of the hip
Differential Diagnosis
- Perthes disease – Central, focal geographic signal abnormality in proximal femoral epiphysis favors idiopathic chondrolysis of the hip. Signal abnormality in Perthes disease is diffuse.
- Septic arthritis – Normal laboratory values in idiopathic chondrolysis of the hip excludes septic arthritis.
Summary
A geometric region of abnormal signal intensity centered within the proximal femoral epiphysis in a child with a painful, stiff hip accompanied by ipsilateral adjacent acetabular bone marrow edema, mild synovial hypertrophy are characteristic early MRI findings of idiopathic chondrolysis. Proposed cause of idiopathic chondrolysis of the hip in children is autoimmune response to articular cartilage antigens released into joint space by autolytic degradation of articular cartilage. Conservative treatment includes analgesics and anti-inflammatory medications. Surgical treatment includes subtotal capsulectomy with muscle release to relieve joint contracture.
Further reads
Laor, T., & Crawford, A. H. (2009). Idiopathic chondrolysis of the hip in children: early MRI findings. AJR. American journal of roentgenology, 192(2), 526–531. https://doi.org/10.2214/AJR.08.1590
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