|Year : 2021 | Volume
| Issue : 4 | Page : 316-317
Multiple bone infarcts around the knee in a middle-aged female
Abhishek Vaish, Raju Vaishya
Department of Orthopaedics and Joint Replacement Surgery, Indraprastha Apollo Hospitals, New Delhi, India
|Date of Submission||09-Jun-2021|
|Date of Decision||03-Jul-2021|
|Date of Acceptance||13-Jul-2021|
|Date of Web Publication||16-Aug-2021|
Department of Orthopaedics and Joint Replacement Surgery, Indraprastha Apollo Hospitals, New Delhi - 110 076, India.
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Vaish A, Vaishya R. Multiple bone infarcts around the knee in a middle-aged female. Apollo Med 2021;18:316-7
A 56-year-old female, presented with a history of acute pain in the left knee for 5 days. She was a known case of chronic kidney disease and had a renal transplant 2 years ago for primary amyloidosis. She is now on steroids and immunosuppressive drugs. The plain radiographs of the knee were normal [Figure 1]. On the magnetic resonance imaging (MRI), there were extensive curvilinear areas of altered signal intensity seen in the distal femur and proximal tibia [Figure 2] and [Figure 3] and were suggestive of multiple bone infarcts. She was managed with a knee splint, physical therapy, and paracetamol. The pain settled within 1 week. Usually, no follow-up imaging is required if the symptoms settle or do not detoriate.
|Figure 2: T1-weighted magnetic resonance imaging images of the knee in coronal and sagittal sections, showing extensive curvilinear areas of altered signal intensity seen in the distal femur and proximal tibia|
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|Figure 3: T2-weighted magnetic resonance imaging images of the knee in coronal and sagittal sections, showing extensive curvilinear areas of altered signal intensity seen in the distal femur and proximal tibia|
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Bony infarcts result from ischemia causing cell death and deterioration of bony architecture. The common causes of these lesions include sickle cell disease, Gaucher disease, Caisson disease, renal transplantation, and corticosteroid use.
Plain radiographs are normal initially, as there is a significant delay between the onset of infarcts and radiographic signs' development. MRI is the investigation of choice in diagnosing these lesions early. Classically, the bony infarcts are sheet-like central lucency surrounded by shell-like sclerosis with a serpiginous border. These lesions may mimic some bone tumours such as enchondroma and nonossifying fibroma.
The bone infarcts have an overall good prognosis. Still, there is a low risk of malignant transformation into fibrous histiocytoma, osteosarcoma, etc. These lesions are mainly managed well with conservative treatment and the management of any underlying cause.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3]