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      Acute Bone Pain following Renal Transplantation: Differentiation between Benign Bone Edema and Avascular Necrosis

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          Two patients are reported who presented within the first 3 months posttransplantation with acute bone pain where serial magnetic resonance imaging (MRI) allowed differentiation between bone edema, which resolved spontaneously, and avascular necrosis (AVN) requiring core decompression. Case 1 had ill-defined images consistent with bone edema that resolved, whereas case 2 developed well-demarcated lesions in the femoral condyles and tibial epiphyses which were confirmed as AVN at surgery. Alternative explanations for bone edema were not evident. We would suggest that in any transplant recipient who develops acute bone pain, MRI is the initial diagnostic modality of choice. Evidence of development of well-demarcated lesions on serial MR scans indicate early AVN. However, on current evidence it is difficult to predict which lesions will progress and until greater experience becomes available, we would recommend intraosseous plethysmography and venography so that incipient or early AVN can be treated by core decompression of the affected bone.

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          Author and article information

          Am J Nephrol
          American Journal of Nephrology
          S. Karger AG
          February 1998
          16 January 1998
          : 18
          : 1
          : 57-60
          Departments of a Nephrology, b Orthopaedic Surgery, c Radiology, and d Pathology, Dunedin Hospital, Dunedin, New Zealand
          13305 Am J Nephrol 1998;18:57–60
          © 1998 S. Karger AG, Basel

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          Figures: 4, Tables: 1, References: 13, Pages: 4
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