Perthes_Disease_Case_Presentation_WhiteYellow.pptx

perthes

1. CASE PRESENTATION PRESENTED BY: Dr. SWATI PGJR2 DEPARTMENT OF RADIODIAGNOSIS

2. Patient Profile Name : MASTER BIKKI MAHATO Age/Sex : 7 Yrs M Date of Admission : 11/07/2025 Hospital : IQ CITY

3. Clinical History Limping gait & left hip pain X 3 weeks Pain referred to knee No H/O trauma/fever Symptoms aggravated by activity

4. Clinical Examination Gait: Antalgic limp (a/k/a Painful gait) Restricted hip abduction and internal rotation No swelling or warmth Positive Trendelenburg sign

5. Radiographic Evaluation Modality: X-ray Pelvis AP & Frog-leg lateral view Findings: • Smaller lef t femoral head • Flattening of epiphysis • Subchondral lucency (crescent sign) • Joint space widening • Lateral displacement

6. MRI Findings Sequence: Coronal T1, T2, STIR Findings: • T1: Hypointense femoral head • STIR: Hyperintense marrow edema • Early ischemic changes • Cartilage preserved

7. Diagnosis Legg-Calv e -Perthes Disease – Lef t hip • Idiopathic avascular necrosis of capital femoral epiphysis • Common i n M >> F Peak presentation at 5-6 yrs.

8. Catterall Classification • Group I – Minimal involvement • Group II – <50% epiphyseal involvement • Group III – >50% involvement with sequestration • Group IV – Total head involvement with flattening

9. Herring Lateral Pillar Classification • Type A: Lateral pillar maintained • Type B: >50% height preserved • Type C: <50% height Used for treatment planning & prognosis

10. Management Plan • Conservative: - Non-weight bearing - Physiotherapy - NSAIDs • Surgical: - Containment procedures if necessary • Regular radiological monitoring

11. Prognosis • Better outcome in younger children (<6 yrs) • Prognosis depends on extent of epiphyseal involvement • Reshaping monitored over 2–4 years

12. Differential Diagnosis • Transient synovitis • Perthes disease • SCFE (slipped capital femoral epiphysis) • Septic arthritis • Juvenile idiopathic arthritis

13. Radiologist's Role • Early detection with MRI • Accurate radiographic staging • Classification (Catterall, Herring) • Monitoring response to treatment

14. Summary • Perthes: AVN of femoral epiphysis in children • Clinical + radiological correlation crucial • MRI for early detection • Role in diagnosis, staging & follow-up

15. References 1. Radiopaedia.org – Perthes Disease 2. Radiographics: Imaging Update on Perthes 3. Catterall A. JBJS 4. Herring JA. JBJS