Adductor Insertion Avulsion Syndrome with Stress Fracture in Morbidly Obese Patient Diagnosed on 18F-Sodium Fluoride Positron Emission Tomography-Computed Tomography

Sharjeel Usmani 1 2, Fahad Marafi 2, Fareeda Al Kandari 1, Najeeb Ahmed 1

Affiliations

01 July 2019

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doi: 10.4103/ijnm.IJNM_77_19

Abstract

Adductor insertion avulsion syndrome, also known as "thigh splints," is a painful condition affecting the proximal to mid-femur at the insertion of the adductor muscles of the thigh. 18F-Sodium fluoride (18F-NaF) is increasingly used in diagnosing skeletal pain which is not identified on radiographs. We report a case of a 56-year-old morbidly obese woman with left hip pain referred for 18F-NaF positron emission tomography-computed tomography (PET-CT) as magnetic resonance imaging cannot be performed due to obesity. 18F-NaF PET-CT shows an increase in tracer uptake at the posteromedial cortex of the upper shaft of left femur. Findings are likely due to adductor insertion avulsion syndrome. 18F-NaF provides important diagnostic information that might alter treatment options.

Keywords: 18F-sodium fluoride positron emission tomography–computed tomography; adductor insertion avulsion syndrome; stress fracture.

Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1 (a) Anterior maximum intensity projection images showing focal spindle-shaped area of increase tracer uptake at upper shaft of left femur (arrow). Increased sodium fluoride uptake also seen at degenerative/arthritic changes at osteophyte at D11, end plates of L4/L5 vertebrae, both knees, and ankle joints. (b-d) Cross-sectional 18F-sodium fluoride positron emission tomography–computed tomography (e) zoomed transaxial images showing focal area of increase tracer uptake at posteromedial cortex of upper shaft of left femur (arrow); corresponding computed tomography showing periosteal thickening with central linear lucency. Findings are likely due to adductor insertion avulsion syndrome with stress fracture

Figure 1 (a) Anterior maximum intensity projection images showing focal spindle-shaped area of increase tracer uptake at upper shaft of left femur (arrow). Increased sodium fluoride uptake also seen at degenerative/arthritic changes at osteophyte at D11, end plates of L4/L5 vertebrae, both knees, and ankle joints. (b-d) Cross-sectional 18F-sodium fluoride positron emission tomography–computed tomography (e) zoomed transaxial images showing focal area of increase tracer uptake at posteromedial cortex of upper shaft of left femur (arrow); corresponding computed tomography showing periosteal thickening with central linear lucency. Findings are likely due to adductor insertion avulsion syndrome with stress fracture

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