Osteonecrosis (Avascular Necrosis) of Knee and Tibia

A 14-year-old boy presented with bilateral knee pain. He had acute lymphoblastic leukemia, B precursor, and had received chemotherapy for 2  years. Following induction and consolidation therapy, maintenance therapy with methotrexate, mercaptopurine, dexamethasone, and vincristine was given. The patient complained of bilateral knee pain in week 103 of maintenance therapy. Physical examination yielded unremarkable findings, and an radiog raphs showed intact bony structures. Magnetic resonance imaging (MRI) showed bone infarction with a “map”-like appearance of bilateral femurs and tibias (Figures 1, 2, and 3; Figures 2 and 3 available at www.jpeds.com).
Source: The Journal of Pediatrics - Category: Pediatrics Authors: Tags: Rediscovering the Physical Exam Source Type: research