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

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          Abstract

          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

          Journal
          AJN
          Am J Nephrol
          10.1159/issn.0250-8095
          American Journal of Nephrology
          S. Karger AG
          0250-8095
          1421-9670
          1998
          February 1998
          16 January 1998
          : 18
          : 1
          : 57-60
          Affiliations
          Departments of a Nephrology, b Orthopaedic Surgery, c Radiology, and d Pathology, Dunedin Hospital, Dunedin, New Zealand
          Article
          13305 Am J Nephrol 1998;18:57–60
          10.1159/000013305
          9481440
          © 1998 S. Karger AG, Basel

          Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

          Page count
          Figures: 4, Tables: 1, References: 13, Pages: 4
          Product
          Self URI (application/pdf): https://www.karger.com/Article/Pdf/13305
          Categories
          Case Report

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