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Hip Pain in Renal Transplant Recipients: Symptomatic Gluteus Minimus and Gluteus Medius Tendon Abnormality as an Alternative MRI Diagnosis to Avascular Necrosis

Andre W. Demant1, Leonardo Kocovic1, Jana Henschkowski2, Klaus A. Siebenrock3, Paolo Ferrari4, Lynne S. Steinbach5 and Suzanne E. Anderson1

1 Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, University of Bern, Freiburg Strasse, 24 Thunstrasses, Bern CH-3010, Switzerland.
2 Department of Nephrology and Hypertension, Inselspital, University of Bern, Bern, Switzerland.
3 Department of Orthopedic Surgery, Inselspital, University of Bern, Bern, Switzerland.
4 Department of Nephrology, Fremantle Hospital, University of Western Australia, Perth, WA, Australia.
5 Department of Radiology, University of California San Francisco, San Francisco, CA.


Figure 1
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  		Fig. 1A —66-year-old woman with bilateral hip pain suspicious for avascular necrosis complicating renal transplantation with MRI of dual findings. Coronal T1-weighted image (TR/TE, 360/17) shows bilateral avascular necrosis of femoral head, marked bilateral fatty atrophy of gluteus minimus muscles, and right-sided greater trochanter bursitis (arrow).

 

Figure 2
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  		Fig. 1B —66-year-old woman with bilateral hip pain suspicious for avascular necrosis complicating renal transplantation with MRI of dual findings. Axial T2-weighted fat-saturated image (3,740/96) shows bilateral avascular necrosis. Crescent sign is noted on left (short arrow), and right-sided tendon abnormalities (long arrow) are seen.

 

Figure 3
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  		Fig. 2A —59-year-old woman with right-sided hip pain and clinical suspicion of avascular necrosis after renal transplantation, with right-sided gluteal tendon abnormalities. Radiographs were negative for softtissue calcification. Coronal T1-weighted image (TR/TE, 480/13) shows focal thickening of gluteus minimus and medius tendons on right with gluteus minimus muscle fatty atrophy.

 

Figure 4
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  		Fig. 2B —59-year-old woman with right-sided hip pain and clinical suspicion of avascular necrosis after renal transplantation, with right-sided gluteal tendon abnormalities. Radiographs were negative for softtissue calcification. Coronal STIR image (3,400/14) shows inflammatory reaction around focally thickened gluteus minimus and medius muscle tendons (arrow).

 

Figure 5
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  		Fig. 2C —59-year-old woman with right-sided hip pain and clinical suspicion of avascular necrosis after renal transplantation, with right-sided gluteal tendon abnormalities. Radiographs were negative for softtissue calcification. Axial T1-weighted fat-saturated images after administration of IV contrast medium (580/14) shown on consecutive images reveal right-sided greater trochanter tendon abnormalities (arrows) and softtissue reaction.

 

Figure 6
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  		Fig. 2D —59-year-old woman with right-sided hip pain and clinical suspicion of avascular necrosis after renal transplantation, with right-sided gluteal tendon abnormalities. Radiographs were negative for softtissue calcification. Axial T1-weighted fat-saturated images after administration of IV contrast medium (580/14) shown on consecutive images reveal right-sided greater trochanter tendon abnormalities (arrows) and softtissue reaction.

 

Figure 7
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  		Fig. 2E —59-year-old woman with right-sided hip pain and clinical suspicion of avascular necrosis after renal transplantation, with right-sided gluteal tendon abnormalities. Radiographs were negative for softtissue calcification. Axial T1-weighted fat-saturated images after administration of IV contrast medium (580/14) shown on consecutive images reveal right-sided greater trochanter tendon abnormalities (arrows) and softtissue reaction.

 

Figure 8
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  		Fig. 2F —59-year-old woman with right-sided hip pain and clinical suspicion of avascular necrosis after renal transplantation, with right-sided gluteal tendon abnormalities. Radiographs were negative for softtissue calcification. Axial T1-weighted fat-saturated images after administration of IV contrast medium (580/14) shown on consecutive images reveal right-sided greater trochanter tendon abnormalities (arrows) and softtissue reaction.

 

Figure 9
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  		Fig. 3A —65-year-old woman with bilateral hip pain clinically suspicious for avascular necrosis of hip after renal transplantation, with bilateral gluteal tendon abnormalities. Conventional radiograph shows bilateral calcifications adjacent to greater trochanter (arrows).

 

Figure 10
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  		Fig. 3B —65-year-old woman with bilateral hip pain clinically suspicious for avascular necrosis of hip after renal transplantation, with bilateral gluteal tendon abnormalities. Axial T1-weighted fat-saturated image after administration of contrast medium (TR/TE, 555/12) shows right-sided focal calcification within gluteus minimus (arrow) and medius muscles and subtle irregularity of greater trochanter.

 

Figure 11
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  		Fig. 3C —65-year-old woman with bilateral hip pain clinically suspicious for avascular necrosis of hip after renal transplantation, with bilateral gluteal tendon abnormalities. Coronal T1-weighted fat-saturated image after administration of contrast medium (562/20) shows bilateral greater trochanteric tendon abnormalities (arrows).

 

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