Male, 5 years old, with sickle cell disease, history of subperiosteal humeral abscess, presenting with back pain, fever, and increasing ESR/CRP. Assess for osteomyelitis. There is a normal complement of vertebral bodies which are in anatomic alignment. Some of the vertebral bodies show early morphologic changes including a slight posterior wedging which likely reflect the underlying sickle cell disease.Marrow signal is diffusely low on T1 weighted images indicating anemia-related marrow reactivity. Superimposed on this is scattered patchy marrow T2 hyperintensity and enhancement, most notably in the T7 and L4 vertebral bodies, and in the T5 and T6 spinous processes. Other levels are affected to a lesser degree. There is no associated osseous destruction, and no paraspinal or epidural fluid collections.The spinal cord and cauda equina demonstrate normal signal and morphology. No pathologic cord or leptomeningeal enhancement is seen. The conus tip terminates at the L1 level which is normal. No spinal canal or neuroforaminal narrowing is seen.Right lower lobe opacification and a right pleural effusion are seen. The urinary bladder is distended.
1.Patchy scattered areas of marrow edema and enhancement are seen, favored to represent osteitis or marrow ischemia. There is no osseous destruction or adjacent fluid collections to suggest infection at this time.2.Additional changes related to sickle cell disease are seen including diffuse marrow reactivity and early vertebral body morphologic abnormalities.3. Right lower lobe opacification and pleural effusion may reflect acute chest syndrome or pneumonia.