Several mentioned the possibility of bone infarct in the context of sickle cell disease or sickle trait.
I don’t know if she has either, but this is why I mentioned that she is African American…since it is at least possible.
It was mentioned that diaphyseal osteomyelitis is common in the setting of SCD and that it can be difficult to distinguish infarct from OM in this context.
This is the only imaging study I have in this young girl, who is obviously very physically active….running 5K races at 11 years of age and playing softball.
I doubt she carries a known diagnosis of SCD…but I can’t know if she has sickle trait.
Considering she is otherwise healthy, I presume this is not multifocal osteomyelitis….and have not suggested that in my report.
And since this is multifocal (midshaft tibia and distal fibular shaft) I don’t think I am dealing with an occult osteoid osteoma, as was suggested…so I have not recommended CT.
Though I was told by one pediatric MSK radiologist that fibular stress fracture at this age is uncommon, it sounds like she has really stressed these bones….and it does look like stress reaction.
Whether or not there is a fracture line, there is marked marrow edema on T1 weighting, not just fluid sensitive images….so this is either fracture or impending stress fracture.
I don’t know if it makes any sense….but I recommended follow up MRI in 4-6 weeks after a period of rest…..and reported this as Grade III Stress Reaction / Impending Stress fracture with apparent superimposed
medullary infarct of the midshaft tibia—which I cannot explain.
Hilary
On Mon, Jul 3, 2023 at 1:37 PM hilary umans <hilary.umans> wrote:
Outside XRs (which I don’t have) reportedly show ? stress reaction with no visible fracture.She is an otherwise healthy African American girl who reports acute onset pain after running a 5K. She also plays softball. The referrer says the pain wakes her at night…..which upsets me.
She has marrow and periosteal edema over a long segment of the midshaft tibia and fibula (the fibula is harder to demonstrate, because it’s thin) with benign appearing periosteal new bone at the tibia.
There is vague slightly bright T2 intracortical signal but no linear cortical defect or fracture line.
I see what looks like bone infarct in the affected tibial segment…though I don’t see that in the fibular segment.
I want this to be stress reaction (Gr III-IV) with fracture or impending stress fracture….but the medullary changes in the tibia confuse me.
I’ve not seen a superimposed medullary bone infarct with stress fracture….though I suppose it could be pre-existing?
Can this possibly be anything else I haven’t thought of?
This is not a good location for infection, so I decided it wasn’t that.
Is there a need for followup MRI?
Is there a reason to suggest CT?
