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Skeletal Radiol (2014) 43:13371340 DOI 10.1007/s00256-014-1906-6
CASE REPORT
Spinal bone marrow necrosis with vertebral compression fracture: differentiation of BMN from AVN
J. S. Nix & R. T. Fitzgerald & R. S. Samant & M. Harrison &
E. J. Angtuaco
Received: 4 December 2013 /Revised: 29 April 2014 /Accepted: 1 May 2014 /Published online: 22 May 2014 # ISS 2014
Abstract Bone marrow necrosis (BMN) is a rare malignancy-associated hematologic disorder characterized by necrosis of myeloid and stromal marrow elements with preservation of cortical bone. Overlap between the imaging appearances of BMN and avascular necrosis (AVN) raises the potential for diagnostic confusion. We report a case of BMN presenting with a traumatic multi-level vertebral body collapse, and finding that may potentially confound distinction between the two entities. We discuss important pathophysio-logic, clinical, and radiologic differences between BMN and AVN with emphasis on features important in the differential diagnosis.
Keywords Bone marrow necrosis . BMN . Avascular necrosis . AVN . Vertebral compression fracture
Introduction
Bone marrow necrosis (BMN) is a rare hematologic disorder in which an incompletely understood microvascular insult leads to necrosis of myeloid tissue and medullary stroma with preservation of cortical bone and spicular architecture [1, 2].
On magnetic resonance imaging (MRI), BMN is characterized by geographic areas of marrow abnormality involving the axial skeleton. Overlap between the imaging appearance of BMN lesions and those of avascular necrosis (AVN), coupled with the fact that BMN is far less commonly encountered in typical imaging practices, may confound formation of an accurate diagnosis when such marrow abnormalities are encountered. Whereas vertebral collapse is a common manifestation of avascular necrosis [3], prior authors have reported that lesions of BMN do not progress to vertebral body collapse [1], implying that the presence or absence of collapse may be used to differentiate between the two entities. Herein, we report a case of biopsy-proven BMN accompanied by multilevel traumatic lumbar vertebral body collapse. To our knowledge, this is only the second reported case of BMN featuring vertebral compression.
Case report
A 66-year-old Caucasian male with a history of diffuse large B-cell meningeal lymphoma presented with complaints of back pain for which an MRI was obtained. He denied a history of trauma. No information regarding bone mineral density was available. Additional...