Hi Ocader´s.
Male patient, 13 years old, with no history of trauma.
Pain in the left hip for a week.
Hip FOPE?
I haven’t seen it outside of the knee …
Is there stress microfracture superior to the epiphyseal line, especially in T2 sequences?
Any other differential diagnosis?
Any input will be welcome!
Kind regards!
André
Thank you all for your comments.
I received 11 responses.
The majority agreed with the FOPE diagnosis!
Hilary umans: This is interesting….to me, it looks exactly like FOPE, though I have never reported it outside of the knee.
Avneesh Chhabra: That is the reason for FAI, bump formation once these lesions heal. > Best! > AC
Beckmann, Nicholas M : I would be concerned about physeal related stress injury. I also haven’t seen a convincing case of FOPE zone outside the knee. FOPE zones in the knee tend not to be peripheral because the physis usually fuses centrally first. Thirteen-year-old male is a good age for SCFE, so we know this is an age and gender that is predisposed to stress related physeal injuries. Particularly in the setting of a symptomatic patient, I think it is prudent to treat this as a stress related injury. Nicholas.
Sergio Viana: For me, classic FoPE. In fact, on CT, you see that this is where physeal closure is furthest along.
Rube: Looks like normal FOPE to me.
María Laura Padilla: Hello! Considering the age, and the lack of trauma, I’d think it’s a good example of FOPE (first seen on the hip for me). The localization and form of edema are very characteristic.
I wouldn’t think of other pathologies of the pediatric hip.
RJ Klecker: This looks like FOPE to me (and I have called it such in similar cases).
Fredrik Moberger: Hi! Sure, my fifty cents for FOPE at this weight bearing growth plate in this joint without effusion. I think we had a phenomenon like that in a kid with similar age that regressed with physeal closure one or two years ago. Best wishes!
/Fredrik Moberger, Sweden.
Filip Vanhoenacker: FOPE DDx: stress fracture; CNO.
Byron Oram: Possibly FOPE, but I wonder if there is a subtle lucent modus medial to the sclerosis on CT scan… therefore raising possibility of early imaging appearances of osteoid osteoma. Correlate clinically (? Night pain, ? Any relief with NSAIDS) and do a follow up scan in 4-6 weeks. Cheers.
Ken Schreibman: I’d consider osteoid osteoma. -KS
Kind regards !