1. Femoroacetabular Impingement (FAI) Morphology: It is a major cause of early osteoarthritis especially in the young and active patients characterised by an early pathologic contact during hip joint motion between skeletal prominences of the acetabulum and the femur that limits the physiologic hip range of motion,
typically flexion and internal rotation.
86% patients have a combination of the Pincer & Cam subtypes of FAI.
(Fig.1)
2. Paralabral cysts: These develop subsequent to labral tears causing forced extrusion of synovial fluid/tissue via a one –way valve mechanism .
In the absence of any other MRI abnormalities in the hip joint as in the present case,
their presence assumes significance as being contributory towards the patient’s symptomatology.
(Fig.2)
3.
Osteoid Osteoma: It is a benign bone tumour quintessentially characterised by night –worsening pain promptly relieved by salicylates.
Typical radiographic findings include an intracortical nidus (with variable amount of mineralization) with cortical thickening and reactive sclerosis in a long bone shaft.
(Fig.3)
4. Snapping Hip Syndrome: This syndrome takes its name after an audible or palpable snap that occurs around the hip during certain movements which may be painful in some cases.
It is classified into external,
internal and intra-articular types,
of which the external type is the most common.
(Fig.4)
5. Osteomyelitis: Basically an infection of the bone marrow it has the potential to progress to osteonecrosis,
bone destruction & septic arthritis.
With its excellent anatomical detail,
superior soft tissue resolution & high sensitivity for detecting early cases MRI remains the best imaging modality in this entity.
(Fig.5)
6. Psoas abscess secondary to pyelonephritis: Inflammatory,
haemorrhagic & neoplastic conditions are the usual culprits in this extraperitoneal space.
Of the multifarious infective etiologies direct extension from contiguous structures (spine,
kidney,
bowel loops & pancreas) remains the customary mode of involvement with Staphylococcus aureus and mixed gram-negative organisms being the commonest causative organisms.
(Fig.6)
7. Bertolotti Syndrome: It refers to the association between lumbosacral transitional vertebrae & low back pain /buttock pain as an independent etiology per se besides PIVD.
An important cause of low back pain in young adults (reported incidence of 18.5% in individuals less than 30 years of age) it is characterised by the presence of a L5 vertebra anatomic variation with a large transverse process that forms a pseudoarthrosis or bony fusion with the sacral basis or iliac crest,
which then proceeds to arthritic changes resulting in chronic/persistent low back ache.
(Fig.7)
8. Neurofibromatosis Type 1: Also known as von Recklinghausen’s disease it is the commonest neurocutaneous syndrome inherited as autosomal dominant with variable clinical & pathological expression.
CNS manifestations occur in 10-20% of all cases & their evaluation is crucial for management decisions.
(Fig.8)
9. Tubercular spondylodiscitis: Infectious spondylodiscitis with its diverse etiology (pyogenic/nonspecific granulomatous/parasitic) frequently leads to devastating neurological complications viz.
spinal deformities & segmental instabilities in the pediatric age group.
(Fig.9)
10. Diffuse idiopathic skeletal hyperostosis (DISH) aka Forestier disease: It is characterised by bony proliferation at sites of tendinous & ligamentous insertions of the spine affecting elderly individuals with a male predominance.
(Fig.10)
11. Medley of adjoining visceral pathologies causing referred pain: Carcinoma Rectum,
Carcinoma Prostate,
Bulky bilateral malignant ovarian masses,
Proctitis etc.
(Fig.11)