Title : Ultrasound evidence findings of bilateral humeral head avascular necrosis in a patient with Systemic Lupus Erythematosus (SLE): A case report
Abstract:
Introduction: A Vascular Necrosis (AVN) is a common complication of SLE, which is due to the disease itself and its treatment. A review of literature showed that only 1 out of 20 cases (5%) of osteonecrosis in SLE will develop at the humeral head, considerably less commonly affected than the femoral head. Imaging modalities such as radiographs and MRI are pivotal for diagnosis, treatment selection, and prognosis of AVN. The usefulness of ultrasound examination in the diagnosis of osteonecrosis is debatable, but may provide some benefit. The objective of this case report is to provide evidence findings of bilateral humeral head AVN using musculoskeletal ultrasound.
Case Presentation: In this case report, we presented a case of a 33-year-old female, diagnosed of SLE, came in to the clinic with bilateral shoulder pain and limitation of movement. She had a history of prolonged corticosteroid use, previous smoker, and alcoholic beverage drinker. Imaging done were radiograph, diagnostic ultrasound and MRI of bilateral shoulder. Radiograph showed flattening of bilateral humeral head, which is suggestive of AVN. MSK US showed cortical defect and cortical irregularities with disruption of the articular margin of the bilateral humeral head. MRI showed subchondral collapse of bilateral humeral head. Patient was not amenable to surgery; hence the case was managed conservatively, through physical therapy.
Conclusion: Musculoskeletal ultrasound can help diagnose avascular necrosis, and add value to future clinical practice as a diagnostic tool that could be done easily, and safely. Especially in cases where other imaging modality such as radiographs and MRI cannot be done immediately, and/or is contraindicated.
Keywords: Systemic Lupus Erythematosus (SLE), A Vascular Necrosis (AVN), Musculoskeletal UltraSound (MSK US)
