Thanks everyone for the responses.
Most people liked Trevors or some variation. Some wondered about unusual heterotopic ossification related to a prior injury. I also got a vote for a very large central osteophyte in severe OA.
Ultimately the discussion is academic, as the patient needed a THA, and ended up getting just that the other day. The surgeon described "cartilaginous tissue at the medial aspect of the acetabulum" which he curetted out. He sent me a picture of what he removed from the acetabular fossa before placing the cup, which I attached to the email. He decided to send it to path, who basically just described bone and cartilage (not surprising).
In the end, I do favor this being a case of acetabular Trevors or intra-articular osteochondroma or some similar variation. I was sent the attached article which describes an "acetabular osteochondroma" which interestingly looks almost identical to my case.
Thanks
Drew
On Tue, Mar 7, 2023 at 5:51 PM Drew Erie wrote:
Hello-
This is a 30 yo M with chronic left hip pain. No prior imaging. Reports a football injury in highschool, but didn’t get any imaging or treatment.
Ortho had him scheduled for a THA tomorrow. He showed me patient’s xrays a couple nights back, which I thought were strange. We decided to get a CT today.
Big osseous overgrowth medial acetabulum with secondary degenerative arthritis. Can see a cleft between this overgrowth and the native acetabulum. Irregularity of acetabular articular surface elsewhere. There are also osteochondral loose bodies.
I’m thinking this is DEH/Trevor’s of the acetabulum presenting in an adult. Does anyone agree or am I crazy? Am I missing something? Not sure how this will impact Ortho’s operative plan.
Thanks for taking a look
Drew
