Diffuse bone marrow serous atrophy

Case contributed by Sammy Tawk
Diagnosis certain


Patient with known anorexia nervosa presented to the emergency department for non-tender left lower limb swelling.

Patient Data

Age: 30 years
Gender: Female

Left ankle


Diffuse subcutaneous edema with loss of soft tissue/fat plane demarcation. Bone demineralization.

Left lower limb


Diffuse subcutaneous edema with heterogeneous appearance of the muscles. No evidence of venous thrombosis.

Diffuse high signal intensity of the subcutaneous fat and the bone marrow of both lower limbs on STIR sequence with corresponding homogenous intermediate signal on T1 weighted sequence. Note the swollen left lower limb compared to the right one.

Case Discussion

This case demonstrates the abnormal MRI signal intensities known as the "flip flop" effect that can be seen in severe anorexia nervosa.

Note that due to these MRI signal abnormalities, an insufficiency fracture can be easily overlooked.

Case courtesy of Dr Pierre TRITSCHLER

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