A 47-Year-Old Woman with Hip Pain After Exercise

Differential Diagnosis

• Femoral head avascular necrosis
• Hip tendinitis and bursitis
• Subcapital hip fracture
• Snapping hip syndrome
• Cortical thickening due to stress reaction or impending stress fracture

Diagnosis

The image shows focal cortical thickening along the medial wall of the femoral neck. This could be due to a stress reaction and be the precursor to a stress fracture. There is no evidence of lucent fracture line.

 

Learnings/What to Look for

• Causes of focal cortical thickening may include osteoid osteoma, chronic infection, and stress fracture—all of which may appear similar on radiographs. As such, more advanced imaging is required

 

Pearls for Urgent Care Management and Considerations for Transfer

• This patient should undergo an MRI. If one is not available on site, she should be referred

 

Acknowledgment: Image courtesy of Teleradiology Associates.