Bone crisis of Gaucher's disease due to bone ischemia: a case report

Bone, bone marrow, and MIBI scintigraphic findings in Gaucher's disease "bone crisis"

PURPOSE

The authors report the utility of Tc-99m MIBI imaging in Gaucher's disease, which results in the accumulation of glucocerebroside in macrophages. Inflated macrophages, or Gaucher's cells, involve the reticuloendothelial organs.

MATERIALS AND METHODS

A 38-year-old man with type I Gaucher's disease, splenectomy, and early bone involvement was examined for a low back "bone crisis." He had a history of total left hip replacement. Results of pelvic radiographs were normal. Magnetic resonance imaging showed complete infiltration of the bone marrow in the lumbar spine and the sacrum. The left iliac bone, the sacrum, and the adjacent part of L5 showed heterogeneously decreased uptake on bone scintigraphs. Hematopoietic bone marrow was absent in these regions and in the left femur. No infection of the prosthesis was revealed with labeled granulocytes.

RESULTS

Avascular necrosis in the left iliac bone was diagnosed, which is a very unusual location. There was no uptake of MIBI in the iliac bones or the femurs.

CONCLUSION

These findings suggest that MIBI may not be a good tool for the evaluation of medullary infiltration by Gaucher's cells.

["Spontaneous" hematoma of the psoas in Gaucher's disease]

The authors report a case of iliac muscle haematoma responsible for inguinal pain in a patient with Gaucher's disease type I. This exceptional cause of pain must now be considered side by side with the classical femoral head osteonecrosis and infectious coxitis. Magnetic resonance imaging appears to be the most sensitive and most specific examination for the aetiological diagnosis of hip pain in Gaucher's disease. In the absence of thrombocytopenia and franck abnormality of coagulation, the spontaneousness of the haematoma is discussed.

The hemipelvis: an unusual site of osteonecrosis. A report of two cases

Osteonecrosis or aseptic necrosis is well-recognised in certain sites. We report two patients, both with predisposing factors, who developed avascular necrosis of the hemipelvis which was bilateral in one case. In each patient the diagnosis was not suspected clinically. In the initial phase, bone scintigraphy showed diminished uptake in the hemipelvis when plain radiographs were normal. Follow-up scans showed evidence of revascularisation. This is an unusual site for osteonecrosis, though there appears to be an underlying anatomical basis for its occurrence.

Ischaemic necrosis of the ilium complicating haemolytic anaemia due to an unstable haemoglobin

A case of ischaemic necrosis of bone (INB) affecting the right hemipelvis in a 57 year old woman with an unstable haemoglobinopathy is presented. The rarity of INB in this site, the usefulness of nuclear scanning, and the relation between haemolytic anaemia and INB are discussed.