11-year-old female with history of leukemia and chronic steroid use now post-transplant with persistent chronic ankle, knee, and hip pain. History of Osteochondritis dissecans of left talar dome. Evaluate avascular necrosis. History: Chronic Steroid Use. Bone infarcts of bilateral distal tibia on ankle MRI. PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: See below.OTHER: Trace amount of free fluid is noted within the pelvis, likely physiologic.BILATERAL HIPS:There is mild collapse and fragmentation of the medial aspect of the left femoral head, with marrow signal changes of the lateral aspect of the left femoral head, compatible with stage III avascular necrosis. Minimal enhancement is noted within the areas of necrosis. The remainder of the proximal left femur demonstrates normal signal intensity. Small left hip joint effusion is present.The right femoral head is normal in bone marrow signal intensity without evidence of avascular necrosis. Remainder of osseous structures of pelvis are normal in appearance and marrow signal intensity.
Stage III avascular necrosis of the left femoral head with small left hip joint effusion.