Presentation
Known patient of sickle cell anemia, presented with right thigh pain, limping gait and difference in girth of of both thighs. To rule out avascular necrosis.
Patient Data
Focal PD hyperintense area seen in the greater trochanteric epiphysis of left femur. Otherwise unremarkable study of both hips and other pelvic bones.
Extensive STIR and PD hyperintense signals are seen involving the anterior elements of both L4 and L5 vertebral body extending to right transverse process and pedicle.
Similar signal changes identified in left iliac wing as well as in multiple region of the first and second sacral elements reaching upto the superior bony margins of both sacroiliac joints. No joint involvement per se.
Case Discussion
Vaso occlusive crisis is a clinical diagnosis. However, musculoskeletal manifestations are usually confined to appendicular skeleton, typically involving the epiphyses of the femur, tibia, humerus etc. The radiographs are usually negative.
In view of their hyposplenism and decreased complement system activity, they are more prone for secondary osteomyelitis. Unfortunately it is difficult to discern solely using MRI between infection and infarction.
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