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Bone Infarcts in Systemic Lupus Erythematosus

Bone Infarcts in Systemic Lupus Erythematosus

A 45-year-old woman presented with longstanding left knee pain.  Radiographs (below) were obtained on February 18 (left) and September 5 (right).

bony necrosis of knee in lupus patient

FINDINGS:  In the radiographs above, the one taken on 2/18 (left) shows subtle densities that are more conspicuous on the radiographs of 9/5 (right). These densities have a serpiginous, well defined, sclerotic border. A lateral image taken on 9/5 appears at left below.

Hand radiographs (below, right) demonstrate ulnar subluxation of the metacarpophalangeal joints, but without erosive changes.

bony necrosis of knee in patient with lupus, lateral viewhands of lupus patient with bony necrosis

An MRI (below, left) demonstrates well demarcated, serpiginous areas with surrounding high and low signal borders. This corresponds to the foci of bone infarct. Atypical is the vast high signal seen within the femur and tibia. A CT image (below, right) demonstrates central sclerotic foci of bone necrosis with large areas of surrounding lucency and cortical destruction of the anterior tibia.

MRI of knee with bony necrosisSagittal reformation of CT showing bony necrosis of knee

 

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