Figure 1
AP pelvis
Marked mature new bone formation is noted in the soft tissues surrounding both hip joints. There is extensive periarticular osseous bridging.
Clinical History
42 year old male with 8 month history of vague hip pain bilaterally. Previous severe motor vehicle accident.
Imaging Findings
42 year old male patient with 8 month history of vague hip pain bilaterally. Previous history of motor vehicle accident.
Discussion
The plain radiographs and CT images demonstrate extensive new bone formation around both hip joints. The new bone abuts both neurovascular bundles, but does not encase them. The MRI images demonstrate increased signal within the new bone indicating the presence of marrow. Heterotopic ossification occurs in approximately 20% of patients with severe spinal injury. It is more common following injuries of the cervical or upper thoracic cord. The soft tissue calcification occurs within months of the injury with bone maturation taking over a year to develop. The aetiology is unknown but there are recognised associations with thrombosis of Batsons plexus and with pressure sores. Symptoms include decreased range of movement and compression of the neurovascular bundle from the new bone. Treatment is aimed at maintaining movement and in cases of significant neurovascular compromise, surgical resection of the new bone may be required.
Differential Diagnosis List
Heterotopic Ossification
Final Diagnosis
Heterotopic Ossification
References
[1] Hsu JD, Sakimura I, Stauffer ES(1975)Heterotopic ossification around the hip joint in spinal cord injury patients. Clin Orthop 112:165-9. (PMID: 811418)
[2] Wittenberg RH, Peschke U, Botel U (1992) Heterotopic ossification after spinal cord injury. Epidemiological risk factors. J Bone Joint Surg Br 74:215-8. (PMID: 1544955)
[3] Colachis SC, Clinchot DM, Venesy D(1993)Neurovascular complications of heterotopic ossification folowing spinal cord injury. Paraplegia 31:51-7. (PMID: 8446448)
[4] Bravo-Payno P, Esclarin A, Arzoz T, Arroyo O (1992) Incidence and risk factors in the appearance of heterotopic ossification in spinal cord injury. Paraplegia 30:740-5. (PMID: 1448303)
[5] Wharton GW(1975) Heterotopic ossification. Clin Orthop 112:142-9. (PMID: 811416)
Case information
| URL: | https://eurorad.org/case/513 |
| DOI: | 10.1594/EURORAD/CASE.513 |
| ISSN: | 1563-4086 |
Figure 3
MRI
Gradient echo, T1 weighted axial images demonstrate increased intensity within the new bone, indicating the presence of bone marrow. The femoral vessels are patent.
AP pelvis
Marked mature new bone formation is noted in the soft tissues surrounding both hip joints. There is extensive periarticular osseous bridging.
MRI
Gradient echo, T1 weighted axial images demonstrate increased intensity within the new bone, indicating the presence of bone marrow. The femoral vessels are patent.