PHOTO READING

STATION
APRIL 1 ST 2021
AD-TIK-DAN
Sdri.N / 30 th / SLE+ Suspek AVN
RM 10426191
31 Maret 2021
 KESIMPULAN

•AVN hip bilateral dengan secondary

OA, Kanan Grade IV, Kiri Grade III,
sesuai klasifikasi Ficat and Arlet
TERIMA KASIH
TEORI
Avascular necrosis (Osteonecrosis)
• Osteonecrosis is a generic term referring to the ischemic death of the
constituents of bone. It has a wide variety of causes and can affect nearly
any bone in the body. Most sites of involvement have an eponym
associated with osteonecrosis of that area, and these sites are discussed
individually as each site has unique clinical, etiologic and prognostic
features.
• Plain radiograph:
• Plain radiographs are negative in early disease. In general, there is initial
minor osteopenia, followed by variable changes, such as patchy sclerosis and rim
calcification. Gradually microfractures of the subchondral bone accumulate in the dead
bone, which is unable to repair leading to the collapse of the articular surface and
the crescent sign of osteonecrosis. Eventually the cortex collapses and fragments, with
superimposed secondary degenerative change.
 Ficat and Arlet Classification of AVN

Stage 0 Stage I Stage II Stage III Stage IV

• plain radiograph: • plain radiograph: • plain radiograph: • plain radiograph: • plain radiograph: end-
normal normal or mixed osteopenia cresent sign and stage with evidence
• MRI: normal minor osteopenia and/or sclerosis eventual cortical of secondary
• clinical symptoms: nil • MRI: edema and/or subchondral collapse degenerative change
• bone scan: increased cysts, without any • MRI: same as plain • MRI: same as plain
uptake subchondral lucency radiograph radiograph
• clinical symptoms: (crescent sign: see • clinical symptoms: • clinical symptoms:
pain typically in the below) pain and stiffness +/- pain and limp
groin • MRI: geographic radiation to knee and
defect limp
• bone scan: increased
uptake
• clinical symptoms:
pain and stiffness
Stage II AVN
Antero-Posterior view of the right
hip x-ray showing alternating
regions of sclerosis and lucency on
superior aspect of femoral head.
Sclerosis indicates areas of new
bone on dead trabeculae. Lucency
indicates resorption of dead
marrow and trabecular meshwork
 Stage III AVN
Right femoral head subchondral lucency, crescent sign, partial collapse and increased density.
Stage III AVN
Axial view of the left hip x-ray
showing a subchondral fracture
line (the “crescent sign”, arrows)
and a cortical discontinuity
(arrowhead) expression of the
collapse of the subchondral
bone in a 28 years old woman, in
dialysis for lupus nephritis,
suffering from hip pain
 Stage IV AVN
Frontal pelvic radiograph shows marked flatening and sclerosis of both femoral heads representing advanced
avascular necrosis