Differential Diagnosis
- Single most likely diagnosis
- Osteoarthritis (OA): The presence of moderate to marked hip joint narrowing, advanced arthritic changes, subchondral sclerosis, and juxta-articular cysts around the left hip joint, along with similar changes in the right hip, strongly suggests OA as the primary diagnosis. The cam-type morphology suspected bilaterally further supports this, as it is a common finding in hip OA, particularly in the context of femoroacetabular impingement.
- Other Likely diagnoses
- Femoroacetabular Impingement (FAI): Given the suspected cam-type morphology bilaterally, FAI is a likely contributing factor to the patient's symptoms and the development of OA changes, especially in the context of the described arthritic changes.
- Enthesopathy: The minor enthesopathic changes throughout the pelvic bones' attachments, including over the greater trochanters bilaterally, suggest an enthesopathic process, which could be related to the patient's overall condition, possibly as a secondary effect of the primary pathology or as part of a broader syndrome.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Avascular Necrosis (AVN): Although not directly indicated by the provided findings, AVN of the femoral head is a critical diagnosis to consider in the context of hip pain and arthritic changes, as it can have a similar presentation and requires prompt treatment to prevent further damage.
- Infection or Septic Arthritis: While the description does not strongly suggest infection, any joint pain or swelling, especially with significant arthritic changes, should prompt consideration of septic arthritis, which is a medical emergency.
- Rare diagnoses
- Rheumatoid Arthritis (RA) or other Autoimmune Arthropathies: Although the primary findings suggest OA, the presence of bilateral hip involvement and minor enthesopathic changes could, in rare cases, be part of a systemic autoimmune condition like RA, especially if other systemic symptoms are present.
- Osteonecrosis related to other systemic conditions (e.g., corticosteroid use, sickle cell disease): These conditions can lead to AVN or other bone and joint abnormalities and should be considered, especially if the patient has a relevant medical history.