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CLINICAL IMAGE Table of Contents  
Ahead of print publication
Multiple bone infarcts around the knee in a middle-aged female


 Department of Orthopaedics and Joint Replacement Surgery, Indraprastha Apollo Hospitals, New Delhi, India

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Date of Submission09-Jun-2021
Date of Decision03-Jul-2021
Date of Acceptance13-Jul-2021
Date of Web Publication18-Aug-2021
 


How to cite this URL:
Vaish A, Vaishya R. Multiple bone infarcts around the knee in a middle-aged female. Apollo Med [Epub ahead of print] [cited 2021 Dec 6]. Available from: https://www.apollomedicine.org/preprintarticle.asp?id=324064




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 1: Plain Xray AP and Lateral view showing no abnormality

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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.[1] The common causes of these lesions include sickle cell disease, Gaucher disease, Caisson disease, renal transplantation, and corticosteroid use.[2]

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.[3] 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.[4] These lesions are mainly managed well with conservative treatment and the management of any underlying cause.[5]

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

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Fondi C, Franchi A. Definition of bone necrosis by the pathologist. Clin Cases Miner Bone Metab 2007;4:21-6.  Back to cited text no. 1
    
2.
Saito N, Nadgir RN, Flower EN, Sakai O. Clinical and radiologic manifestations of sickle cell disease in the head and neck. Radiographics 2010;30:1021-34.  Back to cited text no. 2
    
3.
Hermann G, Singson R, Bromley M, Klein MJ, Springfield D, Abdelwahab IF. Cystic degeneration of medullary bone infarction evaluated with magnetic resonance imaging correlated with pathologic examination. Can AssocRadiol J 2004;55:321-5.  Back to cited text no. 3
    
4.
Lafforgue P, Trijau S. Bone infarcts: Unsuspected gray areas? Joint Bone Spine 2016;83:495-9.  Back to cited text no. 4
    
5.
Graham P. Avascular necrosis and bone infarcts of the knee. Orthopaedic Nurs 2020;39:59-61.  Back to cited text no. 5
    

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Correspondence Address:
Abhishek Vaish,
Department of Orthopaedics and Joint Replacement Surgery, Indraprastha Apollo Hospitals, New Delhi - 110 076, India.
India
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/am.am_53_21



    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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