Vaso-occlusive crises of large bones are one of the most common clinical characteristics of sickle cell anemia (SCA). They must be differentiated from osteomyelitis, at early stages, in order to institute the appropriate treatment. Tc-99m MDP bone scanning may establish the correct diagnosis. The skull is an uncommon site of bone infarction in the SCA patients. A child suffering from SCA was admitted with lower back pain and fever. Twenty-four hours after admission, bilateral palpebral swelling and hematoma was noted (Fig. 1, left). A Tc-99m MDP bone scan was performed. Decreased uptake of the radiopharmaceutical in both orbita (Fig. 2A), and in the third, fourth and fifth lumbar vertebrae (Fig. 3A) was demonstrated and interpreted as multiple bone infarctions in those areas. The periorbitai edema and hematoma resolved at the end of the first week (Fig. 1, right). A follow-up bone scanning performed after 12 days revealed an increased uptake in the periorbitai bones (Fig. 2B).
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