Multifocal bone infarcts
Nephrotic syndrome with both leg and ankle pain, and inability to walk.
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There are irregular, serpiginous abnormal signal lines observed within the medullary space of the distal extremity of the tibia, calcaneus, and talus bilaterally. On PD images, there is a hyperintense line paralleling the inner surface of the hypointense line within the marrow.
Medullary bone infarcts and avascular necrosis are common complications of aggressive or long-term steroid therapy. Diseases such as nephrotic syndrome are commonly treated with corticosteroids, and the clinician and radiologist must be aware in their evaluation for these complications.