PMC9553233_01
(A and B) X-ray demonstrated that the left femoral head exhibited a strip-like low-density area (yellow arrow) but no evidence of stenosis. (C) CT revealed the left femoral head remains regular, the continuity of the upper bone cortex is poor, patchy low-density areas (red arrow) can be seen under the articular surface, edge hardening, and slightly high-density foci can be seen considering the formation of dead bone. (D and E) MRI revealed necrosis of the left femoral head, and effusion in the left joint cavity (blue arrow). (F) No obvious abnormality in Hip X-ray half a year after discharge.
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X-ray demonstrated that the left femoral head exhibited a strip-like low-density area but no evidence of stenosis (Figure 1A and B). CT scan revealed cavity necrosis in the left femoral head (Figure 1C). MRI revealed necrosis of the left femoral head, and effusion in the left joint cavity (Figure 1D and E). In follow-up, the symptoms of left hip pain and movement limitation disappeared almost half a year later, and there was no obvious abnormality in the blood test or hip X-ray (Figure 1F).
(A) Core biopsy of the right femoral head revealed necrotic material stained with HE. (B) Giemsa staining demonstrated scattered positive Brucella (red circle).
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HE staining of a core biopsy of the left femoral head revealed amorphous necrotic material (Figure 2A); Giemsa staining can demonstrate scattered positive Brucella (Figure 2B).
PMC9553233_02
(A) X-ray of the Hip joint showed low signal on the right femoral head (yellow arrow), joint narrowing and even invagination of the joint space. (B) CT showed cavities necrosis and low-density patches of shadows (red arrow) in the right femoral head. (C) MRI showed effusion of the right Hip joint and necrosis of the right femoral head (blue arrow), and the inflammatory fluid diffused with extra-articular. (D-F) X-ray, CT and MRI of the osteonecrosis area four years later are better.
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CT. X-ray of the hip joint showed low signal on the right femoral head, joint narrowing and even invagination of the joint space (Figure 3A). CT showed cavity necrosis and low-density patches of shadows in the right femoral head (Figure 3B). MRI of the hip joint indicates effusion of the right hip joint complicated by necrosis of the right femoral head, and the inflammatory fluid diffused with extra-articular (Figure 3C). Following a follow-up four years later, the pain in the right hip had completely disappeared, and the hip joint was no longer limited in movement; neither the blood tests nor the imaging examinations (Figure 3D-F) revealed any abnormalities.
(A) HE staining showed partial dead bone and inflammatory cellulose exudate in osteonecrosis of the femoral head. (B) Giemsa staining revealed scattered positive Brucella (red circle).
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HE staining in osteonecrosis of the femoral head revealed partial dead bone and inflammatory cellulose exudate (Figure 4A); Giemsa staining showed scattered positive Brucella (Figure 4B).
PMC9553233_03
(A and B) Right femoral head collapsed significantly (yellow arrow), joint space narrowed, and multiple areas of low density were seen (yellow arrow) on X-ray; in the left femoral head, the shape and joint space were normal, and low-density areas (yellow arrow) were visible. (C) CT showed hyperplasia and sclerosis of the bilateral acetabular margins, uneven bone density in the left femoral head (red arrow), and a huge cavity in the right femoral head (red arrow). (D) MRI showed extra-articular inflammatory fluid, bilateral Hip joint effusion and bilateral osteonecrosis of the femoral head (blue arrow), especially on the right side. (E) Right total hip arthroplasty was performed when the inflammatory indexes normalized. (F and G) X-ray showed the left femoral head collapsed and joint space narrowed (yellow arrow). (H) No abnormalities in Hip X-ray at the follow-up in January 2022.
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X-ray revealed that the right femoral head collapsed significantly, the joint space became narrow, and there were multiple areas of low density in the right femoral head; the left femoral head shape was regular, joint space was normal, and low-density area was visible in the left femoral head (Figure 5A and B). CT showed severe bilateral hip dysplasia, uneven bone density in the left femoral head, and a huge cavity in the right femoral head (Figure 5C). MRI of the hip joint showed bilateral effusion and bilateral osteonecrosis of the femoral head, particularly on the right side (Figure 5D). Following three weeks of anti-brucellosis medications, inflammatory indexes returned to normal, and right total hip arthroplasty was performed (Figure 5E); the left femoral head was not treated since it has a regular shape. Both the infection index and the SAT of the patients were standard; an X-ray of the hip joint indicated that the left femoral head collapsed and the joint space narrowed (Figure 5F and G). The patient's symptoms disappeared entirely at the follow-up in January 2022; there were also no abnormalities in blood tests and X-ray of the hip (Figure 5H).