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    Go to the top of the page   ID: 20030819114534 Original case in english  More links about this topic on Pubmed (PubMed Reader)
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    Perthes disease (Necrosis of the femoral head)
    A Nordwig, H Hetschko. Perthes disease (Necrosis of the femoral head). PedRad [serial online] vol 3, no. 8.
    URL: www.PedRad.info/?search=20030819114534


    ( There are questions in the CMK-Mode for this topic )

     
     Pediatric Radiology CasesImages to this case: There are X-Ray-images available for this case. [ X-Ray ] There are Ultrasound-images available for this case. [ Ultrasound ] View all modalities [ All ]   
     Pediatric Radiology CasesAuthor/s:

    A. Nordwig, H. Hetschko (Halle)  

     
     Pediatric Radiology CasesEmail Address:

    Viewable for logged on visitors (Log on)  

     
     Pediatric Radiology CasesAge:

    6 Years  

     
     Pediatric Radiology CasesGender:

    Male  

     
     Pediatric Radiology CasesRegion-Organ:

    Leg-Bones  

     
     Pediatric Radiology CasesMost likely etiology:

    metabolic  

     
     Pediatric Radiology CasesHistory:

    6 year old male, intermittend pain in the right hip for 8 months, occasional limping; Physical therapy for 3 months.
    Examination of the right hip presented the following results:
    - shortened leg
    - palpatory pain in the groin and trochanter major
    - Drehmann-sign positive
    - extension / flexion: 0 / 10 / 120
    - abduction / adduction: 25 / 0 / 30
    - outer rotation / inward rotation: 20 / 0 / 20  

     
     Pediatric Radiology CasesPathomorphology or Pathophysiology of this disease :

    The causes for aseptic bone necrosis of the femoral head are not known. In children, the most common illness is Perthes-Calves disease. Of the spontaneous necroses, mostly children between teh age of 3 and 7 years are afflicted, boys more often than girls. Familial occurance has been noted. Perthes-Calves disease is also seen in combination with the hip dysplasia as early as in the 2nd year of life. Here, the causes can be many: vacular damage and epiphyseal damage through repositional trauma.

    The most commonly used staging criteria:
    a.) Joint space increased
    b.) Epiphysis increased in density and flattened.
    c.) Fragmentation
    d.) Newly formed bone.

    The grade of affliction was categorized by Cattarall:
    I) ventral area of the epiphysis, no sequesters
    II) half of the epiphysis is afflicted, seqester seen, small metaphyseal lesions
    III) 3/4 of the epiphysis is afflicted, large sequester seen, diffuse metaphyseal lesions
    IV) Complete epiphysis is sequestered, dramatic affliction of the metaphyseal region.  

     
     Pediatric Radiology CasesRadiological findings:


    -

    Ultrasound 1 <- view Ultrasound 1

    Ultrasound 1: Hip sonography, ventral. Irregular contours, right femoral head with irregular echo pattern with areas of high echogenicity and low echogenicity. Femoral head is altogether lower in height. Epiphyseal gap is fuzzy with increased echogenicity. Slight joint effusion to the right.

    -



    Ultrasound 2 <- view Ultrasound 2

    Ultrasound 2: Hip sonography, ventral. Right and left sides for comparison.

    -


    X-Ray 1 <- view X-Ray 1

    X-ray 1: Enlargened right joint space. Flattened, increased density in the head, somewhat fragmented. The femoral neck is "chunky" and widened (Image and diagnosis from the Insitute for Radiology, City Hospital Martha-Maria in Halle-Dölau)


     

     
     Pediatric Radiology CasesDiagnosis confirmation:

    Imaging including endoscopy  

     
     Pediatric Radiology CasesWhich DD would be also possible with the radiological findings:

    Particularly at the beginning of the illness, arthritis of various origin; i.e. Coxitis fugax as well as enchondral dysostosis.  

     
     Pediatric Radiology CasesCourse / Prognosis / Frequency / Other :

    Possibility of a periodic illness over many years.  

     
     Pediatric Radiology CasesComments of the author about the case:

    N/A  

     
     Pediatric Radiology CasesFirst description / History:

    N/A  

     
     Pediatric Radiology CasesLiterature:

    N/A  

     
     Pediatric Radiology CasesKeywords:

    Legg-Calve-Perthes disease, juvenile Osteochondronecrosis, Head of the Femur, Hip, femur head, Perthes disease, AVN, avascular necrosis, aseptic bone necrosis, limping, hip pain, knee pain, arthritis, child, childhood, pediatric radiology  

     
     Pediatric Radiology Cases Cite this article:

    A Nordwig, H Hetschko. Perthes disease (Necrosis of the femoral head). PedRad [serial online] vol 3, no. 8.
    URL: www.PedRad.info/?search=20030819114534  

     
     Pediatric Radiology Cases Read similar articles: with corresponding keywords
    in the same field: Leg-Bones
    or in the region: Leg
    or in the tissue/organ: Bones
    or with the etiology: metabolic
     
     Pediatric Radiology CasesImages to this case: There are X-Ray-images available for this case. [ X-Ray ] There are Ultrasound-images available for this case. [ Ultrasound ] View all modalities [ All ]   
     
    Perthes disease (Necrosis of the femoral head)
    A Nordwig, H Hetschko. Perthes disease (Necrosis of the femoral head). PedRad [serial online] vol 3, no. 8.
    URL: www.PedRad.info/?search=20030819114534


    ( There are questions in the CMK-Mode for this topic )

     

    Search similar cases in:
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    Perthes disease (Necrosis of the femoral head)
    Other cases by these authors:

    Search A. Nordwig in Medline A. Nordwig (4)   
    Search H. Hetschko in Medline H. Hetschko (3)   

    Perthes disease (Necrosis of the femoral head)  
     
    Perthes disease (Necrosis of the femoral head)
    A Nordwig, H Hetschko. Perthes disease (Necrosis of the femoral head). PedRad [serial online] vol 3, no. 8.
    URL: www.PedRad.info/?search=20030819114534


    ( There are questions in the CMK-Mode for this topic )

     

    Which diagnosis have other collegues guessed?


    • Epiphysiolysis capitis femoris
      Votes: 5 (19 %)


    • Ewing-sarcoma of the femoral epyphysis
      Votes: 1 (3 %)


    • Dysplasia epiphysaria punktata
      Votes: 1 (3 %)


    • Perthes disease
      Votes: 18 (69 %)


    • Osteosarcoma
      Votes: 1 (3 %)



        Total answers: 26

     
    Perthes disease (Necrosis of the femoral head)
    A Nordwig, H Hetschko. Perthes disease (Necrosis of the femoral head). PedRad [serial online] vol 3, no. 8.
    URL: www.PedRad.info/?search=20030819114534


    ( There are questions in the CMK-Mode for this topic )

     

    Medical Dictionary
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    Perthes disease (Necrosis of the femoral head)
    A Nordwig, H Hetschko. Perthes disease (Necrosis of the femoral head). PedRad [serial online] vol 3, no. 8.
    URL: www.PedRad.info/?search=20030819114534


    ( There are questions in the CMK-Mode for this topic )

     




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