Wednesday, November 13, 2019

Femoral head lesion

F 62, left hip pain. Suspected impingement.

There's a subchondral / subcortical bone lesion at the anterior aspect of the left femoral head with cystic and fatty components, possibly also some calcification.
To me it doesn't look like a typical impingement lesion / herniation pit.
More like cystic degeneration of an intraosseous lipoma, or an LSMFT. 



She also has cartilage changes with subchondral cysts and mild trochanter bursitis (not shown).

What is your impression?
 

3 comments:

  1. Looks chondroid - CT is better to show chondroid matrix.

    If chondroid, I think this lesion is indeterminate (eccentric, epiphyseal), although seems too old for chondroblastoma and old for clear cell chondrosarcoma.

    Our recommendation would be consultation with orthopedic oncology.

    Management would likely be:

    If asymptomatic, radiography follow-up every 6-12 months for 5 years then come back if any symptoms occur.

    If any discomfort, open bx and rx.

    If growth, open bx and rx.

    Rx for young patients: curettage, intra-op cryo and bone grafting
    Rx for older patients: femoral head resection and hip replacement

    The problem is assigning symptoms to the lesion, rather than to OA, labral tears, impingement, abductor tendinopathy...

    ReplyDelete

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