Updated: 6/22/2021

Bone Infarct

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  • summary
    • Bone Infarcts are medullary bony lesions that are in the same spectrum of disease as osteonecrosis. Patients typically present with an asymptomatic lesion in the metaphysis or diaphysis of long bones, discovered incidentally on radiographs.
    • Diagnosis is made radiographically with the presence of a medullary lesion of sheet-like central lucency surrounded by sclerosis with a serpiginous border, commonly referred to as a "smoke up the chimney" lesion. 
    • Treatment is observation as lesions are generally asymptomatic. 
  • Epidemiology
    • Risk factors 
      • similar risk factors as those seen in osteonecrosis
        • trauma, sickle cell disease, thalassemia, connective tissue disorders, Gaucher's disease, steroid use
  • Etiology
    • Mechanism
      • interruption of blood supply by intrinsic or extrinsic factors
  • Presentation
    • Symptoms
      • usually asymptomatic
        • often found when imaging the extremities for other reasons
  • Imaging
    • Radiographs
      • medullary lesion of sheet-like central lucency surrounded by sclerosis with a serpiginous border
        • "smoke up the chimney"
    • MRI
      • key feature is that central signal remains of normal marrow
      • T1 weighted images
        • peripheral low signal due to grannulation tissue and to lesser extent sclerosis
        • periphery may enhance post gadolinium
      • T2 weighted images
        • acute infarct may show ill-defined non-specific area of high signal
        • intense inner ring of granulation tissue and a hypointense outer ring of sclerosis
    • Bone Scan
      • cold in early phases
      • hot in late resorptive and revascularisation phase
  • Treatment
    • Nonoperative
      • observation
        • indications
          • usually asymptomatic and do not require treatment

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(OBQ08.167) A 45-year-old female twists her knee suddenly while playing tennis. She denies any history of knee pain in the past. Radiographs are shown in Figure A. What is the diagnosis?

QID: 553
FIGURES:
1

Bone infarct

80%

(2046/2550)

2

Osteonecrosis

2%

(55/2550)

3

Metastatic carcinoma

1%

(28/2550)

4

Osteosarcoma

0%

(8/2550)

5

Enchondroma

16%

(400/2550)

L 2 D

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