Bone infarction

Case contributed by Dr Mohammed Harraz MD

Presentation

Knee pain and swelling

Patient Data

Age: 31years
Gender: Male
MRI

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 hyper intense 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 this bone which 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 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 bone scan,  there is no uptake where blood supply absent. The treatment for Bone Infarction is aimed at making the joint usable and Prevent further damage to the bone and joint, it includes medical treatments which aim to treats the underlying cause of sickle cell anemia or decrease the excessive use of steroids. Surgical treatment as Decompression Surgery, Osteotomy and Bone Grafting.

 

 

 

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Case information

rID: 54535
Case created: 13th Jul 2017
Last edited: 1st Aug 2017
Inclusion in quiz mode: Included

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