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So

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Starting with the first case, the history we are given is chronic

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Right hip pain, similar to, uh, previous joints.

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I like my coronal images on top, and, uh, a sagittal and axial.

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And as we can see on this, uh, patient's right hip, we have, uh,

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quite robust edema at, uh, on both sides of the joint, uh,

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involving both the ace, talum and femoral head. Uh, and, uh,

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cutting into the neck here. Uh, but what I want us to pay attention to, uh,

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specifically here is

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The,

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Uh, the subtle, uh,

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or minimal irregularity of the subcon bone plate that somewhat

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parallels the contour of the, uh, femoral head. Uh, along with, uh,

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the

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Findings of the robust

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Marrow edema, particularly involving

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The femoral head.

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This finding is compatible with, uh, with a stress fracture,

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presumably insufficiency type. If, uh,

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You know,

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Especially if this person is, uh,

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more elderly and has a history of osteoporosis,

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then you're gonna think of insufficiency, insufficiency type

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Fractures. Uh, that is, uh, stress type fracture that occurs, uh, with,

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uh, normal loads on, uh, abnormal bone. If the patient is,

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uh, younger and just, uh, exercising or overdoing it,

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then obviously that would be a stress fracture fatigue type where you have

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abnormal loads or, or large repetitive amounts of load on, uh,

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more normal bone. Other findings on, uh, uh,

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interesting findings on, on this case are the, uh,

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synovitis along with the joint effusion,

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particularly along the anterior aspect of the femoral head and neck. But, uh,

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what I also wanna point out, uh, it seems that, uh, someone, uh,

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uh, took, uh,

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a wrong jore or perhaps a bite out of the anterior aspect of this femoral head

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and neck. So, uh, I'd be looking for a history of,

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uh, a prior, uh, femoral plasty.

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I don't see any other, uh,

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findings to suggest acetabular plasty or rim trim, but, uh,

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maybe, uh, perhaps a little bone anchor here and maybe a little regularity here.

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But that's something that I'd want to, uh, try to dig, uh,

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for or ask, uh, uh, for assistance on, uh,

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for that history. 'cause that may obviously change the way we read a case.

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But the most salient finding, uh, for this case would be the, uh,

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the subcon insufficiency fracture. Now, obviously,

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the differential diagnosis for this would be avascular necrosis.

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Um, and for that, uh, you typically want to see, um,

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uh, what's been termed the double line sign,

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particularly on your T two weighted sequences, which is, uh,

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sclerosis or the dark T two, uh, surrounding an inner, uh,

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rim of granulation tissue, uh, which is usually too,

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too bright. And then all of that surrounds typically, uh, fatty marrow.

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Um, but that can also be heterogeneous depending on the state of the, uh,

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underlying bone, if it's totally sclerotic and, and ischemic, then that,

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in that case, that could present as dark T one and T two marrow signal. Uh,

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certainly. Okay. So those are probably the, uh, main two, uh,

3:31

differentials for, for this case.