Fw: Knee pain= answer to.. four problems you see here

Hello,

I like to paste everyone’s responses and not favor one over other as people put in considerable their time and effort to send responses. If I missed anyone, let me know..

And the winner is Dr. Daniel Saddik with most findings.

This case is interesting with 4 unique findings.

1. Sickle cell Dis with marrow reconversion and hemosiderosis- notice high signal on opposed phase imaging. Chronic Bone infarcts
2. Patellofemoral impingement findings- notice lucent cleft in femur- it is not an infarct but subcortical edema due to impingement. Also, Hoffa’s edema/patella alta. Attached is snapshot of positional MRI from my dear Colleague Flavio D Silva showing impingement of tendon on femur with tight anterior compartment.
3. Osteochondroma from tibia
4. Edema of medial femur with periosteal edema- white cell count is 14K and patient was placed on Vanco/Zosin. This is the symptomatic site. I think its infection- but its not proven yet as it a fresh case with no biopsy.

Daniel Saddik

Marrow oedema including medial femoral condyle

Bone infarct

Oedema in hoffas fat pad

Osteochondroma

Bhavik Daraniya
Marrow infiltrative disease
Bone infarct in proximal tibia
Small osteochondroma proximal tibia
Patella alta

Sorin Ghiea
1. AVN proximal tibia
2. Small osteochondroma anterolateral tibia
3. patella alta and impingement of hoffa fat pad infero lateral pole of patella
4. diffuse marrow infiltration diaphyseal femoral and tibial, affecting also partially epiphysis (hematological disorder?)
5. distal quadriceps and proximal patellar tendon mild tendinopathy/ tendinosis

Joel Rubenstein
AVN, SIF lat tip plateau, quad tendinosis, red marrow reconversion
Joel Rubenstein

Roy Gottlieb
1. Abnormal marrow signal possibly (red marrow reconversion) possibly secondary to anemia i.e. Sickle Cell Disease although Leukemia/lymphoma may cause similar marrow changes. Other causes including chronic renal disease resulting in anemia.
2. AVN possibly from i.e.Sickle Cell Disease/thalassemia, steroid use, chronic inflammatory/SLE disorders, bone marrow transplant with steroid use, chronic renal disease/ amyloid arthropathy.
3. Osteochondroma of tibia

Best!
AC
Avneesh Chhabra, M.D. M.B.A.

Professor Radiology & Orthopedic Surgery

Chief, Division of Musculoskeletal Radiology

UT Southwestern Medical Center, Dallas, Tx

5373 Harry Hines Blvd.

Dallas, Tx-75390-9178

Office: 214-648-2122

avneesh.chhabra@utsouthwestern.edu<mailto:avneesh.chhabra@utsouthwestern.edu>

www.utsouthwestern.edu<www.utsouthwestern.edu/>

________________________________
From: ocad-msk@googlegroups.com <ocad-msk@googlegroups.com> on behalf of Avneesh Chhabra <Avneesh.Chhabra@UTSouthwestern.edu>
Sent: Thursday, November 3, 2022 9:59 AM
To: OCAD-MSK <ocad-msk@googlegroups.com>
Subject: Knee pain= tell us four problems you see here

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