ALVALAseptic Lymphocyte-Dominated Vasculitis-Associated Lesion (hip prosthesis complication)
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The most characteristic histological features of ALVAL were diffuse and perivascular infiltrates of lymphocytes and plasma cell infiltrates of eosinophilic granulocytes and necrosis.
Caption: Figure 1: Ultrasound of the right hip showing an inhomogeneous hypoechoic fluid collection with internally scattered echogenic debris between the skin and the right greater trochanter measuring approximately 8 x 3 x 2.5 cm which raised the suspicion of a metal-on-metal ALVAL reaction.
Saha et al., "Current literature and imaging techniques of aseptic lymphocyte-dominated vasculitis-associated lesions (ALVAL)," Clinical Radiology, vol.
Another study postulated that there was an increased risk of infection in patients with metallosis since the combination of metal debris, ALVAL and tissue necrosis provided an optimum environment for peri-prosthetic bacterial growth and rapid spread of infection (9).
There is widespread concern regarding the incidence of ALVAL after MoM or metal-on-polyethylene THA.
(29) The term aseptic lymphocytic vasculitis-associated lesions (ALVAL) has been used to describe these features.
- La Rochelle, France-based research and development company Valbiotis (Paris: ALVAL) has received authorization from an independent review board to launch the international REVERSE-IT (Phase IIB1) clinical study of Valedia in the US, the company said.
One of the differential diagnoses of mass lesions after total hip replacement is a metal-on-metal pseudotumour, also known as aseptic lymphocyte-dominant vasculitis-associated lesion (ALVAL), especially around a metal-on-metal hip or knee replacement [25].
(2) Elevated levels of wear have been associated with aseptic lymphocytic vasculitis associated lesions (ALVAL), hypersensitivity, and pseudotumours.
The metal-sensitive patients with an acute picture of chronic inflammation (aseptic lymphocytic vasculitis-associated lesions, ALVALs) seem to be most common.