Presentation
Knee pain and swelling
Patient Data
There are irregular, serpiginous peripheral lines of low T1 and PD fat sat signal intensity observed within the medullary space of the distal femur. On PD fat sat there is a hyperintense line paralleling the inner surface of the hypointense line within the marrow (the double line sign). The double line sign is an MRI finding seen at the periphery of a region of the bone infarct. It is best seen on T2 and PD fat sat weighted sequences and consists of an inner bright line and an outer dark line.
Case Discussion
Bone infarcts are seen in the metaphysis or diaphysis of long bone due to interruption of blood supply to the bone affected, the most common causes are trauma, hemoglobinopathies e.g. sickle cell disease, excess steroids, pancreatitis, alcohol, and Gaucher disease.
MRI is the imaging modality of diagnosis and is characterized by the double line sign which is best seen on T2 and PD fat sat weighted sequences and consists of an inner bright line and an outer dark line.
On a bone scan, there is no uptake where blood supply is absent. The treatment for bone infarction is aimed at making the joint usable and preventing further damage to the bone and joint, including medical treatments which aim to treat the underlying cause of sickle cell anemia or decrease the excessive use of steroids.
Surgical treatments include decompression surgery, osteotomy, and bone grafting.
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