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

Pain due to bone marrow infarction is common in homozygous sickle cell dise ase (SS disease). Musculoskeletal pathology may be responsible for persiste nt atypical symptoms. We have assessed the frequency and ultrasound appeara nces of soft tissue and joint abnormalities in SS disease. SS disease patie nts with atypical musculoskeletal symptoms were examined with ultrasound ov er a 2 year period. Ultrasound findings were correlated with those at surge ry or percutaneous drainage. 31 episodes in 23 patients were referred for u ltrasound. There were 36 abnormalities in 18 patients: abscess (n=15), effu sions (n=5), soft tissue induration (n=12), fat necrosis (n =2), haematoma (n = 1) and reactive lymph node (n = 1). Five examinations were normal. Sof t tissue abnormalities in patients over the age of 14 years were associated with intramuscular injections: fat necrosis (n=1), haematoma (n=1), indura ted 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 drainag e.