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Multiple Bone Infarcts from Sickle Cell Disease

• Avascular necrosis may be caused by:

  • Diseases in the blood vessels (thrombi, emboli, abnormal cells) like:

    • Sickle-cell disease

    • Gaucher's Disease

    • Polycythemia

    • Caisson Disease

    • Pancreatitis
       

  • Diseases of the blood vessels (intima or wall) like:

    • Collagen-vascular disease vasculitis

    • Radiation-induced avascular necrosis (mediated by vasculitis)
       

  • Diseases outside of the blood vessel like:

    • Trauma
       

• In all, the blood supply is interrupted which leads to necrosis of bone

• MRI and Nuclear Med bone marrow imaging most sensitive in making diagnosis

• Plain films are least sensitive

Sickle-cell thrombosis and infarction

• Occurs in diaphyses of children (sickle dactylitis) and metaphyses and epiphyses of adults

• Produces dystrophic medullary calcification (DDx: enchondroma)

• There may be juxta-cortical sclerosis

• Lincoln log = H-shaped = codfish vertebrae in spine

• Femoral head may collapse in time

• Secondary degenerative arthritis will develop over time in affected joints

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