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Case 069

Avascular necrosis of the humeral head

A painful shoulder

This patient complained of chronic shoulder pain.

Findings

The two views are both AP views of the shoulder, but with slightly different angulation of the tube. On the second view, the humeral head is no longer overlapped by the acromioclavicular joint. The area of sclerosis in the humeral head is thus better visualised.

This is the snowcap sign, an early feature of avascular necrosis. It is said to be more common in dysbaric osteonecrosis, but can occur in other varieties. There was no obvious predisposing factor in this case.

Ref: Bone and Joint Imaging, Resnick D, p. 973

Diagnosis

Avascular necrosis of the humeral head

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