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Sickle cell anemia
6%
96/1558
Thalassemia
9%
147/1558
Gaucher's disease
14%
216/1558
Chronic prednisone use
133/1558
Infection
61%
957/1558
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The radiographic findings are consistent with a bone infarct. While generally benign, the risk factors of bone infarcts are similar to those of avascular necrosis: Gaucher's, thalassemia, sick cell anemia, and steroid use. Bone infarcts are benign and asymptomatic incidental findings noted on x-rays, generally obtained for different reasons. They are thought to be in the same category of diseases as avascular necrosis which is thought to be due to the interruption of blood supply by both intrinsic and extrinsic factors: sickle cell disease, thalassemia, connective tissue disorders, Gaucher's disease, and steroid use. The characteristic "smoke up the chimney" showing a medullary lesion of central lucency surrounded by sclerosis is often noted. Treatment is generally just observation. Kanthawang et al. discussed a case report of an 18-year-old man with homozygous β-thalassemia presenting with a fever and severe acute bilateral ankle pain concerning for septic joint or osteomyelitis. MRI studies showed an acute bone infarction in the metaphysis of bilateral distal tibias. The authors discuss that while bone infarcts are complications noted in sickle cell hemoglobinopathy they can also occur in other hemoglobinopathies such as thalassemia. Gould et al. discuss an in-depth review of 13 potential bone tumor mimickers that can assist a radiologist in correctly identifying these benign lesions and in avoiding misdiagnosis and related morbidity. The authors also noted that the review will also aid the radiologist in making appropriate recommendations to the referring physician for the management or further imaging. Figure A and B are AP and lateral radiographs of the knee showing the characteristic "smoke up the chimney" appearance seen in bone infarcts Incorrect Answers: Answer 1: Sickle cell anemia is thought to be a risk factor for bone infarct. Answer 2: Thalassemia is thought to be a risk factor for bone infarct. Answer 3: Gaucher's disease s thought to be a risk factor for bone infarct. Answer 4: Chronic steroid use is thought to be a risk factor for bone infarct.
1.5
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