Avascular necrosis of the femoral heads

This is the case of a 29 year old female who presents with progressively worsening right hip pain. A frontal radiograph of both hips was obtained. Evaluation of the right hip demonstrates diffuse sclerosis of the right femoral head with fragmentation and collapse of the articular surface. The left femoral head demonstrates a snowcapped appearance with diffuse sclerosis of the femoral head. There is no fragmentation or subchondral collase of the left femoral head. Findings are consistent with avascular necrosis, with end stage avascular necrosis of the right femoral head with secondary osteoarthritis. The differential diagnosis for AVN is broad and includes sickle cell disease, alcohol use, post-trauma, and chronic corticosteroid use.