Prevalence and Patterns of Occult Hip Fractures and Mimics Revealed by MRI
Mayumi Oka1,2 and
Johnny U. V. Monu1
1 Department of Radiology, University of Rochester School of Medicine and
Dentistry, University of Rochester Medical Center, 601 Elmwood Ave., Box 648,
Rochester, NY 14642.
2 Present address: Department of Radiology, Johns Hopkins Hospital, 600 N Wolfe
St., Baltimore, MD 21287.
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Fig. 1A. —77-year-old woman with fracture of greater trochanter after
fall. Fracture was difficult to visualize on conventional radiographs. Frontal
radiograph of left hip appears to show normal findings.
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Fig. 1B. —77-year-old woman with fracture of greater trochanter after
fall. Fracture was difficult to visualize on conventional radiographs.
T1-weighted coronal image of left hip shows linear low-signal focus
(arrowheads), indicating fracture.
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Fig. 2A. —67-year-old woman who presented with persistent right hip
pain after fall 3 weeks earlier. Frontal radiograph of right hip shows
unremarkable findings.
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Fig. 2B. —67-year-old woman who presented with persistent right hip
pain after fall 3 weeks earlier. Coronal T2-weighted image shows abnormally
high signal in anterior column of hip and in area of superior pubic ramus,
consistent with trabecular fracture. Linear abnormally high signal is seen in
adductors and obturator externus and is compatible with presence of
interstitial edema or hemorrhage.
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Fig. 3A. —73-year-old man who experienced hip pain after fall. He had
no fractures, but MRI showed muscle injury. T1-weighted coronal image shows
abnormal signal of interstitial muscle hemorrhage (arrows) in
obturator externus muscle near its attachment to greater trochanter and in
musculotendinous junction.
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Fig. 3B. —73-year-old man who experienced hip pain after fall. He had
no fractures, but MRI showed muscle injury. T2-weighted coronal image shows
abnormal signal in obturator externus muscle near its attachment to greater
trochanter and in musculotendinous junction. These findings are compatible
with interstitial hemorrhage (arrows).
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Fig. 4A. —81-year-old woman with abscess in iliopsoas muscle who
presented with left hip pain, no history of trauma, and clinical suspicion of
occult fracture. T1-weighted axial image shows rounded low-signal focus
(arrow) adjacent to left iliacus muscle.
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Fig. 4B. —81-year-old woman with abscess in iliopsoas muscle who
presented with left hip pain, no history of trauma, and clinical suspicion of
occult fracture. T2-weighted image shows central area of high signal
surrounded by concentric focus of low- and high-signal zones, consistent with
abscess (solid arrow). Abnormally high signal in iliacus muscle
(open arrows) is result of muscle inflammation.
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Fig. 5. —74-year-old woman with iliopsoas avulsion injury after fall 2
days before MRI examination. T2-weighted axial fast spin-echo fat-suppressed
image shows abnormally high signal (arrows) in and surrounding
iliopsoas muscle, which is consistent with partial tear of muscle and
surrounding hemorrhage. Note also some abnormal signal around gluteus minimus
muscle (asterisks).
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Copyright © 2004 by the American Roentgen Ray Society.
