Presentation
Bilateral shoulder pain and left knee pain.
Patient Data
Subchondral lucencies within both humeral heads, with subtle flattening on the right.
Subchondral lucencies at the medial femoral condyle.
No joint effusion. The cruciate and collateral ligaments are normal. No evidence of a meniscal tear was identified.
There is evidence of an infarction of the distal femur consistent with the underlying diagnosis of sickle cell disease. There is also evidence that osteochondritis dissecans of the medial femoral condyle is likely to be responsible for current symptoms. No detached intra-articular fragment was identified. There were no other significant findings.
The significant abnormality relates to the appearance of the medial femoral condyle, consistent with osteochondritis dissecans.
Case Discussion
Osteonecrosis is a common complication in patients with sickle cell anaemia, which this patient has a known history of, and is thought to occur in between 10-50% of patients. The most commonly affected sites are the hips and shoulders.
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