Presentation
Right hip pain.
Patient Data
Antalgic position.
There is a complete loss of the right superior femora acetabular joint space.
Destruction of the acetabular roof. (Compare with the thick contralateral acetabular cortex.)
Osteopaenic femoral head.
The medial FAJ space is mildly widened (Waldenstrom's sign)
Diffuse marrow edema within the right femoral head and neck, as well as the acetabulum which extends to involve AIIS. There is destruction of the posterosuperior femoral head and adjacent acetabulum. A large joint effusion is present. Para-acetabular muscle edema is noted which involves the gluteal muscles most severely.
Case Discussion
The findings in this case are are typical of septic arthritis of the hip.
This is an emergency best managed by urgent aspiration for microscopy, culture and sensitivity. Chondrolysis can be rapid depending on the virulence of the organism and results in joint destruction, as in this case.
Suspect septic arthritis in any patient presenting with an acute monoarthritis.
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