Age: 15 years. Sex : Male. Indication: Reason: right hip pain with hgbSS, hx avascular necrosis, want to assess for septic hip, wanting imaging down to right knee History: pain, fever. 01/18/15 No fracture or dislocation is identified. There is deformity of the right femoral head. Decreased T1 and increased T2 signal within the right femoral head reflects avascular necrosis. There is a minimal amount of fluid within the right hip joint.There is a small area of abnormal signal intensity in the left femoral mid diaphysis. There is abnormal signal intensity throughout the right femoral diaphysis, mainly within the mid to distal diaphysis. There is approximately 3mm elevation of the medial periosteum with fluid extending along 16.7 cm total length of the right femur. There is adjacent soft tissue edema. Postcontrast sequences demonstrate enhancement of the mid to distal right femoral diaphysis and surrounding soft tissues. There is rim-like enhancement along the thin fluid collection.
Extensive bone changes involving predominantly the mid and lower diaphysis of the right femur with a sliver of elongated fluid in the subperiosteal region and surrounding edema. Differential diagnosis includes acute bone infarct with reactive fluid and edema or osteomyelitis with a subperiosteal abscess.