Memoirs of a Radiologist : Avascular Necrosis an Initial Hunch

In this series, I would like to take the audience through my memory lanes, some of them are exalted experiences in Radiology that shall help people seeking second opinion. As a practicing Radiologist, I have enjoyed my journey throughout especially with Teleradiologyhub.com, sharing multiple reporting tasks and coordinating with expert's panel. 

Panic and Radiology: Inseparable Duo

I recount here an old experience of mine which has taught me that no moment is discounted if you are on your toes. Work towards it. Somewhere last year, I happened to handle a case of a young female patient. She was in her late twenties, she came to our radiology department with significant pain.

She was asked by her consultant to come along with a report of CT study of both hip joints on 32 slice CT machine. She had little idea where it can be done in budget She found Teleradiologyhub.com as a booking option for discounted CT scans across In India.

The young lady had difficult history of long term pain in her left hip. Her consultant advised a CT study for that. She successfully had a CT scan undertaken at our facility. I was able to see the thick and thin slice CT images.

CT Scanning Process and my assumption

I immediately identified that the head of the left lower long bone(femur) was flattened and fragmented. Normally the head should be spherical. By assessing the CT images and correlating with the clinical condition of long term hip pain, my diagnosis could not have been anything but avascular necrosis (AVN) of head of femur. This was my guiding star. The initial hunch led me to find the historic footprints of the desease and narrow my focus.

(For those who don't know: AVN or Avascular Necrosis is the sequel due to lack of blood supply to a particular bone, in this case it is the head of the femur.)

Awareness shapes up Diagnostic Confidence

There could be multiple reasons for pathology related to AVN. It could be trauma which can be accidental. It could be a type of blood disorder. It was possible due to long term usage of steroid or alcohol or smoking. In this particular case, it was due to steroid usage during Covid infection. Management of this pathology depends on the severity of the involvement of the bone and joint. But whatever may be the reason now Senior Consultants know how to handle such patient. To know that it was AVN is very much appreciated.

Radiologists rated on Delivery Time ( TAT)

Radiology goes to normally unseeable parts of these systems and gives us proper indication of impact. It was within reasonable limit we were able to triangulate the findings. The diagnosis was atypical but we arrived that with the initial hunch in mind. It suggested that with clear understanding one can even determine the outcomes of the report in few seconds.