Crescent sign

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A radiograph of a left hip joint, which reveals a thin, curvilinear lucent line parallel to the cortical margin of the femoral head, in a patient with avascular necrosis. Crescent sign annotated.jpg
A radiograph of a left hip joint, which reveals a thin, curvilinear lucent line parallel to the cortical margin of the femoral head, in a patient with avascular necrosis.

In radiology, the crescent sign is a finding on conventional radiographs that is associated with avascular necrosis. [1] [2] [3] It usually occurs later in the disease, in stage III of the four-stage Ficat classification system. [1] It appears as a curved subchondral radiolucent line that is often found on the proximal femoral or humeral head. [1] Usually, this sign indicates a high likelihood of collapse of the affected bone. [1] The crescent sign may be best seen in an abducted (frog-legged) position. [1] [4]

The crescent sign is caused by the necrotic and repair processes that occur during avascular necrosis. [1] [2] Osteosclerosis occurs at a margin where new bone is placed over dead trabeculae. [1] When the trabeculae experience stress leading to microfractures and collapse, the crescent sign appears. [1]

The crescent sign may be seen with other bone diseases, such as shear fractures. [1]

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References

  1. 1 2 3 4 5 6 7 8 9 Pappas, J. N. (2000). "The musculoskeletal crescent sign". Radiology. 217 (1): 213–214. doi:10.1148/radiology.217.1.r00oc22213. PMID   11012446.
  2. 1 2 Kenzora, J. E.; Glimcher, M. J. (1985). "Pathogenesis of idiopathic osteonecrosis: The ubiquitous crescent sign". The Orthopedic Clinics of North America. 16 (4): 681–696. doi:10.1016/S0030-5898(20)30435-1. PMID   4058896.
  3. Norman, A.; Bullough, P. (1963). "The Radiolucent Crescent Line--An Early Diagnostic Sign of Avascular Necrosis of the Femoral Head". Bulletin of the Hospital for Joint Diseases. 24: 99–104. PMID   14048829.
  4. "Rheumatology Image Bank: Avascular Necrosis, Crescent Sign: Ficat Stage III, Hip" . Retrieved 26 June 2012.