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Incidental osteonecrosis in the distal left femur in a case of beta-thalassemia with COVID-19: Role of [99mTc]Tc-MDP whole-body bone scan
, 2
Affiliations- Nuclear Medicine Department, Hazrate Rasool Akram Hospital, Teheran, Iran
- Rasoul Akram Hospital, Iran University of Medical Science, Teheran, Iran
open access
Abstract
Secondary anemia in hemoglobinopathies like thalassemia can cause expansion of the bone marrow cavities because of compensatory marrow hyperplasia. This case demonstrates spontaneous osteonecrosis of the distal left femur in a patient with β-thalassemia that may be secondary to ischemic infarction secondary to occlusion of the microvasculature within the expanded cancellous bone. This subject was referred to Hazrat Rasool Akram Hospital because of fever, cough, and bone pain. In the CT scan she had scattered peripheral CGO in both lungs due to COVID-19 with two paravertebral masses due to extramedullary hematopoiesis. The patient had also generalized bone pain so the physician asked for a whole-body bone scan and incidentally, we found a cold lesion with a rim of increased uptake in the distal left femur that with bone biopsy it was consistent with osteonecrosis. This case illustrates the importance of performing a whole-body bone scan in β-thalassemia for the management of patients and diagnosis of occult osteonecrosis.
Abstract
Secondary anemia in hemoglobinopathies like thalassemia can cause expansion of the bone marrow cavities because of compensatory marrow hyperplasia. This case demonstrates spontaneous osteonecrosis of the distal left femur in a patient with β-thalassemia that may be secondary to ischemic infarction secondary to occlusion of the microvasculature within the expanded cancellous bone. This subject was referred to Hazrat Rasool Akram Hospital because of fever, cough, and bone pain. In the CT scan she had scattered peripheral CGO in both lungs due to COVID-19 with two paravertebral masses due to extramedullary hematopoiesis. The patient had also generalized bone pain so the physician asked for a whole-body bone scan and incidentally, we found a cold lesion with a rim of increased uptake in the distal left femur that with bone biopsy it was consistent with osteonecrosis. This case illustrates the importance of performing a whole-body bone scan in β-thalassemia for the management of patients and diagnosis of occult osteonecrosis.
Keywords
osteonecrosis; case report; paravertebral mass; COVID-19
About this articleTitle
Incidental osteonecrosis in the distal left femur in a case of beta-thalassemia with COVID-19: Role of [99mTc]Tc-MDP whole-body bone scan
Journal
Issue
Vol 26 (2023): Continuous Publishing
Article type
Clinical vignette
Pages
46-48
Published online
2023-02-16
Page views
2780
Article views/downloads
360
DOI
Pubmed
Bibliographic record
Nucl. Med. Rev 2023;26:46-48.
Keywords
osteonecrosis
case report
paravertebral mass
COVID-19
Authors
Raheleh Hedayati
Masume Soltanabadi
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