CASE 9836 Published on 30.12.2011

Leg pain and anaemia (ECR 2011 Case of the Day)

Section

Musculoskeletal system

Case Type

Clinical Cases

Authors

David J Wilson; Georgina M Allen

Oxford University Hospitals; Oxford/UK
Email:david.wilson@ndorms.ox.ac.uk
Patient

32 years, female

Categories
Area of Interest Musculoskeletal bone ; Imaging Technique MR
Clinical History
A female patient aged 32 from Barbados presented with left leg pain and anaemia. The pain was worse at night and there was a low grade fever. Left femoral X-ray (Fig. 1-2), chest X-ray (Fig. 3) and MRI of the left femur (Fig. 4) was performed.
Imaging Findings
The femur radiographs show extensive well organised laminated periosteal reaction and bone sclerosis. MR shows a heterogeneous signal pattern in bone with low signal central areas on a FSTIR image. This pattern fits with chronic osteomyelitis with necrotic central areas. Bone infarction should also be considered. The adjacent soft tissue oedema surrounds areas of low signal suggesting abscess formation.
The chest radiograph shows moderately plethoric lung field, she was anaemic with a high cardiac output. The stomach gas bubble extends to the left chest wall, a sign to suggest that the spleen is small or has been removed.
Discussion
Autosplenectomy, anaemia and a high cardiac output at rest suggest homozygote sickle cell disease.
Bone infarction is common in this condition. The affected areas of bone may be complicated by osteomyelitis. Although salmonella infection is regarded as a hall mark of sickle cell osteomyeltitis the majority of cases are due to staphylococcus aureus.
Differential Diagnosis List
Sickle cell disease and osteomyelitis (Salmonella osteomyelitis)
Staphylococcus osteomyelitis
Previous splenectomy
Final Diagnosis
Sickle cell disease and osteomyelitis (Salmonella osteomyelitis)
Case information
URL: https://www.eurorad.org/case/9836
DOI: 10.1594/EURORAD/CASE.9836
ISSN: 1563-4086