Sonographic detection and characterization of musculoskeletal and subcutaneous tissue abnormalities in sickle cell disease.

Abstract

Pain due to bone marrow infarction is common in homozygous sickle cell disease (SS disease). Musculoskeletal pathology may be responsible for persistent atypical symptoms. We have assessed the frequency and ultrasound appearances of soft tissue and joint abnormalities in SS disease. SS disease patients with atypical musculoskeletal symptoms were examined with ultrasound over a 2 year period. Ultrasound findings were correlated with those at surgery or percutaneous drainage. 31 episodes in 23 patients were referred for ultrasound. There were 36 abnormalities in 18 patients: abscess (n = 15), effusions (n = 5), soft tissue induration (n = 12), fat necrosis (n = 2), haematoma (n = 1) and reactive lymph node (n = 1). Five examinations were normal. Soft tissue abnormalities in patients over the age of 14 years were associated with intramuscular injections: fat necrosis (n = 1), haematoma (n = 1), indurated soft tissue (n = 1) and abscess (n = 7). Soft tissue abnormalities with no underlying cause were seen in seven patients: abscess (n = 4), indurated soft tissue (n = 2) and fat necrosis (n = 1). Ultrasound is the imaging modality of choice for delineating these abnormalities and allows percutaneous drainage.

A pseudoaneurysm within a subperiosteal collection in a patient with sickle cell disease

“…6 Sidhu and Rich described a subperiosteal abscess as a hypoechoic collection with its base adjacent to a bone, without intervening soft tissue, extending into the surrounding muscle, representing an inflammatory exudate dissecting in a subperiosteal plane. 5 Our case fits this description in the setting of SCD and especially with abnormal inflammatory parameters. However, our patient also had abnormal color flow signal from a cortical vessel.…”

“…1 One of the reasons for the high frequency of infection in patients with SCD could be the reduced immuno-competence related to sludging of distorted red blood cells in the spleen. 5 Hyposplenism secondary to infarction and subsequent fibrosis is also an important factor, as are impaired phagocytosis and complement dysfunction. 6 Sidhu and Rich described a subperiosteal abscess as a hypoechoic collection with its base adjacent to a bone, without intervening soft tissue, extending into the surrounding muscle, representing an inflammatory exudate dissecting in a subperiosteal plane.…”

“…This case adds to the known spectrum of musculoskeletal abnormalities resulting from this condition. 5…”

Bone involvement in sickle cell disease

“…Ultrasonography shows the extraosseous pathology in acute osteomyelitis and may show periosteal elevation (William et al, 2000). It has also the advantage of being rapid, non-invasive and fairly simple to target to the area(s) of maximum pain (Sidhu & Rich, 1999). The sensitivity of ultrasonography in diagnosing osteomyelitis in sickle cell disease has been reported to be as high as 74% (Rifai & Nyman, 1997;Sadat-Ali et al, 1998;William et al, 2000;Riebel et al, 2003).…”

Sonographic Characterisation of Tissue Changes Associated with Infused Apomorphine Hydrochloride: A Case Series

“…9,[12][13][14] Numerous studies have used ultrasound to described a range of superficial focal and diffuse skin appearances including tumour, lipoma, haematoma, lymphoma, abscess, cellulitis and panniculitis. 9,10,13- 16 We used ultrasound to investigate subcutaneous appearances in people using apomorphine infusions and found that in every case the infusion sites had markedly abnormal sonographic appearances compared to control areas.…”