EC Paediatrics

A 12-year-old child with known sickle cell disease presented with inflammatory-type pelvic pain. There was no associated fever, and the infectious work-up was negative. Given the inflammatory characteristics of the pain, a rheumatologic disorder was initially considered. Laboratory investigations showed negative HLA-B27 testing and a negative rheumatoid factor. Magnetic resonance imaging (MRI) of the pelvis was subsequently performed. Coronal and axial fluid-sensitive sequences demonstrated multiple areas of abnormal bone marrow signal involving the pelvic bones and the proximal femora. The lesions were geographic and relatively well defined, with characteristic serpiginous margins and increased signal intensity on fluid-sensitive sequences. On T1-weighted images, the lesions showed peripheral serpiginous low-signal-intensity rims with relative preservation of the central marrow signal. The multifocal distribution and characteristic morphology of these lesions, in the setting of known sickle cell disease, were highly suggestive of multifocal bone infarctions.

Keywords: Sickle Cell Disease (SCD); Magnetic Resonance Imaging (MRI); Inflammatory-Type Pelvic Pain; Multifocal Bone Infarctions