Which skeletal manifestations of sickle cell disease (SCD) are caused by infarction of bone and bone marrow?

Updated: May 12, 2021
  • Author: Joseph E Maakaron, MD; Chief Editor: Emmanuel C Besa, MD  more...
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Answer

Infarction of bone and bone marrow in patients with sickle cell disease can lead to the following changes (see images below):

  • Osteolysis (in acute infarction)
  • Osteonecrosis (avascular necrosis/aseptic necrosis)
  • Articular disintegration
  • Myelosclerosis
  • Periosteal reaction (unusual in the adult)
  • H vertebrae (steplike endplate depression; also known as the Reynold sign or codfish vertebrae)
  • Dystrophic medullary calcification
  • Bone-within-bone appearance
Skeletal sickle cell anemia. H vertebrae. Lateral Skeletal sickle cell anemia. H vertebrae. Lateral view of the spine shows angular depression of the central portion of each upper and lower endplate.
Skeletal sickle cell anemia. Bone-within-bone appe Skeletal sickle cell anemia. Bone-within-bone appearance. Following multiple infarctions of the long bones, sclerosis may assume the appearance of a bone within a bone, reflecting the old cortex within the new cortex.

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