“Missing head sign”
Deepak Gautam, Rajesh Malhotra
The Pan African Medical Journal. 2017;28:300. doi:10.11604/pamj.2017.28.300.13384

PAMJ - Clinical Medicine PAMJ OH PAMJ OH PAMj OH
"Better health through knowledge sharing and information dissemination "

Images in medicine

“Missing head sign”

Cite this: The Pan African Medical Journal. 08/12/2017 ;28:300. doi:10.11604/pamj.08/12/2017 .28.300.13384

Received: 16/07/2017 - Accepted: 17/09/2017 - Published: 08/12/2017

Key words: Femoral head, missing, tuberculosis of hip

© Deepak Gautam et al. The Pan African Medical Journal - ISSN 1937-8688. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Available online at: http://www.panafrican-med-journal.com/content/article/28/300/full

Corresponding author: Rajesh Malhotra, Department of Orthopedics, All India Institute of Medical Sciences, New Delhi 110029, India (rmalhotra62@hotmail.com)

“Missing head sign”

Deepak Gautam1,2, Rajesh Malhotra2,&


1Wellcome Trust DBT/India Alliance Fellow, 2Department of Orthopedics, All India Institute of Medical Sciences, New Delhi 110029, India



&Corresponding author
Rajesh Malhotra, Department of Orthopedics, All India Institute of Medical Sciences, New Delhi 110029, India



Image in medicine    Down

A 56 years old male, farmer by occupation, presented with an altered gait. Five years back he had pain in right hip associated with fever and loss of body weight. On investigation, Erythrocyte Sedimentation Rate was raised (70 mm in first hour), X-ray revelaed dimunition of joint space and erosion of articular margins (A). On further investigation he was found to be mantoux test positive. Based on the clinicoradiological finding, he was started on Antitubercular Therapy (ATT). He was well counselled regarding the duration of treatment and the need of regular intake of drugs as prescribed from a nearby Directly Observed Treatment Short Course (DOTS) centre. After starting ATT, the fever subsided. The pain gradually settled. However, still he was having painless limp. He took ATT for 18 months as per our protocol. Two years later he followed up. X-ray revealed loss of major part of femoral head (B). The treatment options were discussed with the patient. As he was not having any problem in doing his activities of daily living, he did not opt for any surgical intervention rather went with a shoe raise option. A year further when he followed up, the X-rays revealed near complete loss of femoral head (C). At latest follow up, his x-rays showed that the femoral head was completely missing (D). We have given an acronym to this unusual presentation as a “Missing Head Sign”. As the patient was still managing his activities of daily living despite the limp, we have just kept him in regular follow up.


Figure 1: serial x-rays of the right hip of the patient in Anteroposterior view showing complete resolution of the femoral head at the latest follow up


























The Pan African Medical Journal articles are archived on Pubmed Central. Access PAMJ archives on PMC here

Volume 35 (January - April 2020)

Article tools

PDF (304 Kb)
Contact the corresponding author
Download to Citation Manager
Reference Manager

This article authors

On Pubmed
On Google Scholar

Navigate this article


Femoral head
Tuberculosis of hip

Rate this article


PAMJ is a member of the Committee on Publication Ethics
PAMJ Authors services
Next abstract

PAMJ is published in collaboration with the African Field Epidemiology Network (AFENET)
Currently tracked by: DOAJ, AIM, Google Scholar, AJOL, EBSCO, Scopus, Embase, IC, HINARI, Global Health, PubMed Central, PubMed/Medline, Ulrichsweb, More to come . Member of COPE.

ISSN: 1937-8688. © 2020 - Pan African Medical Journal. All rights reserved