A 32-year-old African-American woman with sickle cell disease presents with acute onset of severe left hip pain, fever, and inability to bear weight. WBC is 18,000/μL. MRI hip shows areas of low T1 and high T2 signal in the femoral head without contrast enhancement. Which complication is most likely?
- A Septic arthritis from Staphylococcus aureus
- B Osteomyelitis from Salmonella species
- C Avascular necrosis (osteonecrosis) of the femoral head ✓
- D Vaso-occlusive bone pain crisis
Explanation
Avascular necrosis (osteonecrosis) of the femoral head is among the most common bone complications of sickle cell disease, resulting from vaso-occlusion of the medullary microcirculation supplying subchondral bone. MRI is the most sensitive imaging modality: low T1 signal (bone edema/infarction) and high T2 signal in a characteristic subchondral location without enhancement indicates avascular necrosis. Salmonella osteomyelitis is a well-recognized infection in SCD but typically shows cortical destruction and periosteal reaction with different MRI characteristics. Both hips should be evaluated as bilateral AVN occurs in 50% of SCD patients.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.