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1. Legg-Calvé-Perthes disease; subchondral fracture

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Figure 61-1

Legg-Calvé-Perthes disease; subchondral fracture.

A, B. Anteroposterior (AP) and frog-lateral radiographs of a 9-year-old child show a curvilinear subchondral lucency (arrows). There is only subtle increased radiodensity of the femoral head in this child.

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2. Legg-Calvé-Perthes disease

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Figure 61-2

Legg-Calvé-Perthes disease.

This child with early manifestations of Perthes disease has subtle increased radiodensity of the left femoral head. The ossified portion of the femoral head is smaller than that of the normal right hip. The femoral head is slightly irregular, there is mild lateral displacement, and there is mild osteopenia of the acetabulum and femoral metaphysis.

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3. Legg-Calvé-Perthes disease

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Figure 61-3

Legg-Calvé-Perthes disease.

The findings in this 3-year-old boy include flattening/sclerosis of the epiphyseal ossification center, cartilage thickening, growth plate widening, and irregular metaphyseal lucencies.

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4. Legg-Calvé-Perthes disease

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Figure 61-4

Legg-Calvé-Perthes disease.

A. This 4-year-old child with left hip pain has an irregular proximal femoral epiphysis. B. Three months later, a large lucency has developed in the central aspect of the epiphysis and there is increased density medially and laterally. C. Reossification is apparent on an image obtained 6 months after the initial image. There is mild lateral extrusion of the wide and flat femoral head. D. An image obtained 1 year after (C) shows further reossification and remodeling. There is mild coxa magna.

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5. Legg-Calvé-Perthes disease

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Figure 61-5

Legg-Calvé-Perthes disease.

A, B. Pinhole bone scintigraphy images in neutral (A) and frog-lateral (B) positions show absent uptake in the right capital femoral epiphysis (arrow). Uptake in the physis is normal. The left hip is normal.

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6. Legg-Calvé-Perthes disease

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Figure 61-6

Legg-Calvé-Perthes disease.

A. A T1-weighted image of a 2-year-old boy shows subtle hypointensity of the right femoral head ossification center relative to the normal center in the left hip. B. A linear hypointense focus (arrow) is visible on this sagittal T1-weighted image; this is a subchondral fracture. C. There is complete lack of enhancement of the right ossification center on this fat-suppressed T1-weighted image obtained with IV gadolinium.

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