Multifocal bone infarcts

Case contributed by Bahman Rasuli
Diagnosis almost certain

Presentation

Patient under long-term corticosteroid therapy due to an autoimmune disease complained from knee pain bilaterally.

Patient Data

Age: 30 years
Gender: Male
mri

There are irregular, serpiginous abnormal signal lines observed within the medullary space of the distal of the femur and proximal of tibia bilaterally. On PD images, there is a hyperintense line paralleling the inner surface of the hypointense line within the marrow.

Degenerative changes are seen at the knee joints bilaterally as followed:

Cartilage loss at the medial femorotibial compartments

Marginal and patellofemoral osteophyte formation

Baker cyst

Radial tearing at the medial meniscus body

Case Discussion

Medullary bone infarcts and avascular necrosis are common complications of aggressive or long-term steroid therapy.

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